COLUMBIA  LIBRARIES  OFFSITE 

HEALTH  SCIENCES  STANDARD 


HX64072339 
RK701  G67  1 895    Dental  medicine,  a  m 


intlieCttpofllmgork 

^tfjool  of  Bcntal  anb  0vai  ^urgerp 


■   library  of 

Dr.  carl  F.  W.  BODECKER 

1846-1912 

The  gift  of 

Dr.  Henry  and  Dr.  Charles  Bodecker 

1929 


^Bl' 


Digitized  by  the  Internet  Arciiive 

in  2010  with  funding  from 

Open  Knowledge  Commons 


http://www.archive.org/details/dentalmedicinema1895gorg 


DENTAL  MEDICINE. 

GORGAS. 


STANDARD  WORKS 

FOR  DENTAL  STUDENTS  AND  PRACTITIONERS. 

Published  by  P.  BLAKISTON,  SON  &  CO. 


Harris. — The  Principles  and  Practice  of  Dentistry.     I2th  Edition.     Thor- 
oughly Revised  and   Enlai-ged.     By  Prof.  F.  J.   S.  Gorgas.     1086 

Illustrations.     1225  Pages, Cloth,  $7.00  ;  Leather,  ^8.00 

Harris. — Dictionary  of  Medicine,  Dentistry,  and  Collateral  Sciences.     5th 

Edition.     Revised  by  Prof.  F.  J.  S.  Gorgas,  .    .    .  Cloth,  15.00;  Sh.,  6.00 

Richardson. — Mechanical  Dentistry.     6th  Edition,    .    .  Cloth,  $4.50;  Sh.,  5.50 
Potter. — Compend  of  Anatomy.     5th  Edition.     Illustrated  by  Lithograph 

Plates  and  many  Wood  Cuts, Cloth,  1. 00 

Talbot. — Irregularities    of    the   Teeth   and  their  Treatment.     2d  Edition. 

234  Illustrations, Cloth,  3.00 

Blodgett. — Dental  Pathology.     Illustrated, Cloth,  1.75 

Puxton. — Anaesthetics.     2d  Edition.     Illustrated, Cloth,  1.50 

Fillebrown. — Text-book  of  Operative  Dentistry.     Illustrated,  .    .    .  Cloth,  2.50 

Taft. — Operative  Dentistry.    4th  Ed.     136  Illustrations.    Cloth,  ^4.25  ;  Sh.,  5.00 

White. — The  Mouth  and  Teeth.     Illustrated, .Cloth,  .50 

Barrett. — Dental  Surgery.     2d  Edition, Cloth,  1.25 

Gorgas. — Dental  Materia  Medica  and  Therapeutics.     5th  Edition,  .  Cloth,  4.00 

Heath. — Injuries  and  Diseases  of  the  Jaws.    4th  Edition.    Illus.    Cloth,  net,  4.50 

Heath. — Lectures  on  Certain  Diseases  of  the  Jaws.     Illustrated,    .  Boards,  i.oo 

Kirkes. — Physiology.     13th  Edition.     Illustrated,    .  Cloth,  ^4.00 ;  Leather,  5.00 

Tomes. — Dental  Surgery.     Illustrated.     3d  Edition, Cloth,  5.00 

Tomes. — Dental  Anatomy.     4th  Edition.     Illustrated, Cloth,  4.00 

Stocken. — Dental  Materia  Medica.     3d  Edition, Cloth,  2.50 

Tumbull.^ — Artificial  Anaesthesia.     3d  Edition.     Illustrated, 3.00 

Sev/ell. — Dental   Surgery,  including   Special  Anatomy  and    Surgery.     3d 

Edition.     200  Illustrations, Cloth,  3.00 

Yeo. — Manual  of  Physiology.    6th  Edition.    321  Illus.,    Cloth, ^3.00;  Sh.,  3.50 

Flagg. — Plastics  and  Plastic  FiUing.     4th  Edition, Cloth,  4.00 

Potter. — Compend  of  Materia  Medica.     6th  Edition.     Illustrated,    .  Cloth,  i.oo 

Brubaker. — Compend  of  Physiology.    Illustrated.     7th  Edition.  .    .  Cloth,  i.oo 

Holden. — Anatomy.    6th  Edition.     311  Illus.,  .  Cloth  or  Oil-Cloth  Binding,  3.00 
Potter.— Hand-Book   of    Materia   Medica,    Pharmacy   and   Therapeutics. 

5th  Edition.     Revised, Cloth,  ^4.50;  Leather,  5.50 

Warren. — Compend   of    Dental    Pathology   and   Dental    Medicine,   with 

Chapter  on  Emergencies.     2d  Edition.     Illustrated, Cloth,  1.00 

Warren. — Compend  of  Dental  Prosthesis  and  Metallurgy.      129  Illus.,  .    .  1.50 


Catalogues  of  Medical  and  Dental  Books  sent  upon  applicatiott. 


DENTAL  MEDICINE 


A  MANUAL 


OF 


DENTAL  MATERIA  MEDICA 


AND  THERAPEUTICS 


BY 

FERDINAND  J.  S.  GORGAS,  A.  M.,  M.D.,  D.  D.  S., 

Editor  of  "  Harris'  Principles  and  Practice  of  Dentistry,"  and  "  Harris'  Diction- 
ary OF  Medical  Terminology  and  Dental  Surgery,"  Professor  of  the 
Principles  of  Dental  Science,  Dental  Surgery,  etc.,  in  the 
University  of  Maryland,  Baltimore. 


FIFTH  EDITION.     REVISED  AND  ENLARGED. 


PHILADELPHIA: 
P.  BLAKISTON,  SON  &  CO., 

No.   10 1 2  Walnut  Street. 
1895. 


Entered,  according  to  Act  of  Congress,  in  the  year  1894,  by 

P.  BLAKISTON,  SON  &  CO., 

In  the  Office  of  the  Librarian  of  Congress,  at  Washington,  D.  C. 


PresB  of 

The  Jas.  B.  Rodgera  Printing  Co. , 

52  <»  54  N.  Sixth  Street, 

Philadelphia. 


PREFACE  TO  FIFTH  EDITION. 


The  many  commendatory  notices  which  have  been  be- 
stowed upon  the  preceding  editions  of  the  "  Dental  Medicine," 
and  the  favor  with  which  they  have  been  received  by  the 
dental  profession,  and  the  value  attached  to  them  by  dental 
students  as  text-books,  have  been  very  gratifying  to  the 
author.  He,  therefore,  presents  the  Fifth  Edition  with  the 
hope  that  it  may  prove  to  be  a  more  complete  treatise  than 
its  predecessor  upon  the  important  subject  of  dental  materia 
medica  and  therapeutics. 

The  object  of  the  author  in  the  preparation  of  this  new 
edition  has  been  to  endeavor  to  bring  the  work  up  to  the 
present  status  of  dental  medicine,  for  the  purpose  of  increas- 
ing its  usefulness  as  a  text-book  and  work  of  reference. 

Important  additions  have  been  made,  many  new  remedies 
described.  The  number  of  useful  and  valuable  recipes  in- 
creased, and  the  formulae  carefully  corrected. 

Among  the  remedies  added  to  the  present  edition  are  the 
following :  Sodium-Peroxide,  Pental,  Europhen,  Aseptol, 
Glycozone,  Coryl,  Chloride  of  Ethyl,  Tropacocaine,  Kalium- 
Natrium,  Trikresol,  Loretin,  Phenosalyl,  Formalin,  Diaph- 
therin,    Boricin,    Dermatol,    Strophanthus,    Vaselone,   Cam- 

phoid,  Gaultheria,  Catechu,  Carbolate  of  Camphor,  Carbolate 

7 


PREFACE   TO   FIFTH   EDITION, 


of  Cocaine,  Benzol-pseudo-tropein,  Oxyquinaseptol,  Sulpho- 
phenol,  Mono-chlor-ethene,  Tri-methyl-ethylene,  Di-iodo- 
form,  CarboHzed  Cosmoline,  Eugenol-acetamid,  Electrozone, 
etc.,  etc. 

Many  new  and  valuable  recipes  have  been  added  together 
with  valuable  tables  for  preparing  percentage  solutions,  meas- 
uring liquids  by  drops,  etc.,  etc. 

Considerable  additions  have  also  been  made  to  the  text  of 

the  older  remedial  agents,  and  also  to  the  Diagnosis  of  the 

Affections  of  the  Mouth,  Characteristics  of  the  Tongue,  etc., 

etc. 

Ferdinand  J.  S.  Gokgas. 

Hamilton  Terrace,  Baltimore,  Md.,  Jan.  i,  1895. 


PREFACE  TO  FOURTH  EDITION. 


In  presenting  a  fourth  edition  of  the  "Dental  Medicine"  to 
the  dental  profession,  the  author  desires  to  express  his  grate- 
ful appreciation  for  the  favor  with  which  every  one  of  the 
preceding  editions  has  been  received,  and  the  kind  notices 
they  have  elicited. 

The  history  of  the  Third  Edition  has  been  similar  to  that 
of  the  first  and  second  editions,  every  copy  having  been  dis- 
posed of  some  months  before  the  present  edition  was  ready 
for  publication. 

So  much  has  been  added  to  this  (fourth)  edition,  in  order 
to  bring  the  work  up  to  the  present  status  of  dental  materia 
medica  and  therapeutics,  that  the  author  cherishes  the  hope 
that  its  value  as  a  text-book  and  work  of  reference  has  been 
greatly  increased  over  that  of  former  editions. 

Considerable  matter  has  been  added  to  Diagnosis  of  the 
Affections  of  the  Mouth,  the  different  Remedial  Agents,  the 
various  substances  classed  as  dental  materia  medica,  with 
their  medicinal  properties,  action,  dental  uses  and  mode  of 
application ;  among  the  number — Arsenious  Acid,  Carbolic 
Acid,  Aromatic  Sulphuric  Acid,  Tannic  Acid,  Chloroform, 
Nitrous  Oxide,  Chloral,  Antipyrene,  Antifebrin,  Bichloride  of 
Mercury,  Peroxide  of  Hydrogen,  Creolin,  Chloride  of  Methyl, 
Sulphonal,  etc.,  etc. 

A  new  chapter  has  been  added  on  the  use  of  Antiseptics  in 
Dental   Practice,  which   includes   the   Sterilization  of  Dental 


10  PREFACE  TO   FOURTH   EDITION. 

and  Surgical  Instruments.  The  list  of  new  antiseptics,  disin- 
fectants, germicides  and  hypnotics,  etc.,  referred  to  in  the 
present  edition,  includes  Aristol,  Rromol,  Campho-Phenique, 
Phenol-Camphor,  Chloralamide,  Synthetic,  Carbolic  Acid, 
Biniodide  of  Mercury,  Iodine  Tri-Chloride,  Chloral-Phenol, 
lodophenacetin,  Lysol,  Bichloride  of  Methylene,  Microcidine, 
Myrtol,  Phenacetine,  Pyoktanin,  Salol,  Sodium  Silico-Fluo- 
ride,  Salipyrene ;  also  the  effects  of  the  Vermilion  of  Vulcan- 
ized Rubber  on  the  Mouth,  Test  Papers  for  Dentists,  List  of 
New  Remedies,  Rendering  the  Hands  Aseptic,  Organic  and 
Inorganic  Acids,  and  Carbon  Compounds,  Alkalies  and  Alka- 
line Earths. 

A  number  of  new  and  valuable  formulae  have  also  been 
added,  and  the  Index  to  "  Dental  Diseases  and  Remedies " 
has  been  correspondingly  increased. 

Ferdinand  J.  S.  Gorgas. 

Hamilton  Terrace,  Baltimore. 
October  i,  i8gi. 


PREFACE  TO  THIRD  EDITION. 


In  presenting  a  third  edition  of  the  "  Dental  Medicine," 
the  author  trusts  that  the  new  matter  it  contains,  comprising 
nearly  one  hundred  pages,  will  add  to  its  value  as  a  text- 
book, and  increase  its  usefulness  to  the  dental  practitioner. 
The  universal  favor  with  which  the  preceding  editions  have 
been  received  is  gratefully  appreciated,  and  the  fact  that, 
like  the  "  Principles  and  Practice  of  Dentistry,"  the  second 
edition  of  the  "  Dental  Medicine  "  was  exhausted  for  several 
months  before  the  present  one  could  be  prepared  for  publi- 
cation, is  an  evidence  of  its  favorable  reception.  What  the 
author  deems  an  improvement,  has  been  made  in  the  arrange- 
ment of  a  portion  of  the  subject  matter  of  the  present  edition, 
and  considerable  additions  have  been  made  to  a  number  of 
subjects,  among  them  being  the  following:  Diagnosis  of  the 
Affections  of  the  Mouth,  General  and  Local  Anaesthesia, 
the  Action  of  Arsenious  Acid  as  a  Devitalizing  Agent,  etc., 
etc. 

In  the  new  matter  will  be  found  :  The  Action  of  Antisep- 
tic Agents,  The  Proper  Use  of  Antiseptics  in  Dental  Practice, 
The  value  of  Germicides  and  Disinfectants,  The  Digestibility 
of  Foods,  Incompatibility,  etc.,  etc.  To  the  Dental  Materia 
Medica  and  Therapeutics  have  been  added  such  agents  as 
lodol,  Hydronaphthol,  Bromides  of  Ammonium,  Calcium, 
Lithium,  Sodium,  Benzoates,  Lithium  and  its  Preparations, 
Phosphates  and  Phosphites,  Creolin,  Cresylic  Acid,  Hydrate 

11 


12  PREFACE   TO   THIRD   EDITION. 

of  Amylene,  Herbst's  Obtundent,  Lanolin,  Kandol,  Methyl 
Chloride,  Nux  Vomica,  Turpentine,  Rhubarb,  Paraldehyde, 
Sodium  and  its  Preparations,  Sulfanol,  Stenocarpine,  Sali- 
cylates, Serpentaria,  Prunus  Virginiana,  Naphthalene,  Guaiacol, 
Cod-liver  Oil,  Colchicum,  Sulphite  of  Aluminium,  Anthemis, 
Antifebrin,  Antipyrene,  Aloes,  Acetanilide,  Sulphurous  Acid, 
Ammonia  and  its  Preparations,  Cresylicum,  Aromatic  Bitters, 
etc.,  etc.,  etc.  A  number  of  new  formulae  have  also  been 
added,  and  the  Index  to  "  Dental  Diseases  and  Remedies  " 
has  been  correspondingly  increased. 

Ferdinand  J.  S.  Gorgas. 
Hamilton  Terrace,  Baltimore. 


PREFACE  TO  THE  FIRST  EDITION. 


This  work  has  been  prepared  by  the  author  in-  deference 
to  many  requests  from  former  pupils,  and  has  been  compiled 
from  lectures  delivered  by  him  in  dental  institutions  during 
the  past  twenty-five  years,  and  notes  obtained  from  the 
standard  works  on  Materia  Medica  and  Therapeutics,  and 
also  from  personal  experience  as  a  dental  practitioner  and 
teacher. 

While  the  author  claims  the  credit  of  the  compilation,  he 
does  not  claim  originality  in  the  sources,  derivations,  medical 
properties  and  action  of  the  various  articles  of  dental  materia 
medica  which  are  given  in  this  work. 

His  intention  has  been  to  present  not  alone  his  own  ideas 
as  to  the  particular  application  of  remedies,  but  also  those 
of  well-known  and  acknowledged  authorities,  and  in  such  a 
manner  as  may  be  of  service  to  the  dental  student  in  acquiring 
a  knowledge  of  this  important  branch  of  his  profession ;  hence 
nothing  has  been  presented  in  this  work  that,  in  the  author's 
opinion,  is  not  applicable  to  dental  practice,  and  that  will  not 
be  of  benefit  to  the  dental  student. 

The  dental  formulary  comprises  many  valuable  combina- 
tions, and  credit  has  been  given,  in  every  case  where  it  was 
possible,  to  the  authors  of  the  different  preparations. 

The  necessity  for  an  American  work  of  this  kind  has  long 
been  apparent,  and  after  years  of  delay  and  promises  the 
author  gratefully  dedicates  this  work  to  his  former  pupils  in 
the  dental  institutions  with  which  he  has  been  and  is  now 
connected,  in  the  capacity  of  a  teacher. 

Hamilton  Terrace,  Baltimore, 

13 


CONTKNTS, 


Prefaces  ........ 

Definition  of  Subjects  ...... 

Action  of  Medicinal  Substances  ..... 

Inflammation,  with  Special  Reference  to  Oral  Mucous   Membrane  . 
Important  Points  in  Diagnosing  Affections  of  the  Mouth,  wnth  a  Synopsis 

of  Treatment    ....... 

Characteristic  Indications  of  the  Tongue 

Abbreviations,  with  Latin  and  English  Terms    . 

Approximate  Measurements    ...... 

Fineness  of  Powder  ....;. 

Weights  and  Measures  ...... 

Metric  or  French  Decimal  System  of  Weights  and  Measures  . 
Rules  for  Regulating  Doses  ..... 

Topical  Remedies  ...... 

The  Endermic  Method  ...... 

The  Hypodermic  Method  ..... 

Setons  and  Issues      .  .  .  . 

General  Bloodletting        ...... 

Local  Bloodletting  by  Leeching,  Cupping  and  Scarifications 
Electricity  as  a  Therapeutic  Means  in  the  Treatment  of  Disease 
Incompatibility  ....... 

Table  of  Doses  of  all  Officinal  Medicines,  Expressed  in  Terms  of  both 

the  Apothecaries'  and  the  Decimal  Metric  System  of  Weights  and 

Measures    .  -  . 

Poisons — Symptoms  and  Antidotes     ..... 

The  Pulse  ........ 

Pulsation  per  Minute  at  Various  Ages  .... 

Respiration  at  Various  Ages         ...... 

Thermometers  ....... 

15 


FAGB 

7-13 

17 

17 

18 

46 

78 
82 

84 
84 

85 
86 
89 

91 

91 

91 
92 

93 

93 

94 

100 


102 

113 
120 
121 
123 
123 


16  CONTENTS. 


PAGE 

Table  of  Elementary  Substances  .....  125 

Table  of  the  Solubility  of  Chemicals  in  Water  and  Alcohol  .  126 

Classification  of  Medical  Substances         .  .  .  .  .128 

Definitions  of  the  Various  Classes  of  Medicinal  Agents        .  .  130 

Forms  in  which  Medicinal  Substances  are  employed     .  '.  .160 

Source,  Derivation,  Medical  Properties  and  Action,  and  Therapeutic  Uses 
of  Medicinal  Substances  Employed  in  Dental  Practice;  Together 
with  their  Dental  Uses  and  Application     .  .  .  .164 

Administration  of  General  Anaesthetic  Agents  .  .  .  224 

The  Dangers  of  Anaesthesia  ......         234 

Preventive  Measures  Against  the  Dangers  of  Anaesthesia        .  .  234 

Treatment  of  Dangerous  Symptoms  of  Anaesthesia  ,  .  .         235 

Methods  of  Resuscitation — Sylvester's  Method — Hall's  Ready  Method  236 

"  ''  Howard's  Method,  etc.     .  .  .  238 

Local  Anaesthesia  .......         239 

Rapid  Breathing  as  a  Pain  Obtunder  .....  242 

Periods  for  the  Eruption  of  the  Teeth       .  .  .  .  .560 

Authorities  Consulted  .  .  .  .  .  .  5^2 

Index  to  Dental  Formulary  and  Dental  Diseases  .  .  .         563 

General  Index  .  .  .  .  .  .  .  5^9 


DENTAL  MEDICINE. 


DEFINITION  OF  SUBJECTS. 

Materia  Medica  is  that  branch  of  medical  science  which  re- 
fers to  and  describes  the  methods  and  substances  known  as 
"  medicinal  agents,"  which  are  employed  in  the  prevention 
and  treatment  of  disease. 

Therapeutics  is  that  branch  of  medical  science  which  com- 
prises the  doctrine  of  the  management  of  disease.  Generally, 
however,  the  term  is  restricted  to  a  description  of  the  modus 
operandi  of  medicines,  or,  in  other  words,  their  use,  application 
and  effects  when  applied  in  the  treatment  of  various  morbid 
conditions.  An  accurate  knowledge  of  the  principles  and 
rules  which  govern  the  administration  and  action  of  medicinal 
substances  enables  the  practitioner  to  restore  disordered 
functions,  and  to  so  impress  the  organism  as  to  maintain  har- 
monious conditions,  by  means  of  which  the  various  functions, 
in  a  state  of  health,  are  intimately  connected  by  relation  and 
sympathy. 

Some  medicinal  agents  exert  their  influence  on  primary 
nourishment,  converting  food,  by  digestion,  into  the  substance 
of  organic  beings,  while  other  remedies,  without  interfering 
with  digestion,  by  a  modification  of  the  process  of  assimilation 
exert  a  destructive  influence  upon  the  tissues.  Some  medi- 
cinal agents  affect  the  nervous  system,  and  others  are  so  irri- 
tant in  their  effects  as  to  cause  their  speedy  expulsion  ;  while 
others,  again,  have  a  particular  affinity  for  certain  organs,  and 
are  eliminated  by  them,  the  effects  ceasing  as  soon  as  the 
evacuation  is  completed.  Other  medicinal  agents  prevent 
septic  decomposition  and  the  growth  of  micro-organisms.    • 

What  are  known  as  topical  or  external  remedies  act  directly 
upon  the  parts  to  which  they  are  applied,  and  their  general 
effects  are  produced  through  the  nervous  system. 

2  17 


18  DENTAL  MEDICINE. 


INFLAMMATION : 
WITH    SPECIAL    REFERENCE   TO    ORAL    MUCOUS    MEMBRANE. 

Definition  of  Conditions  Associated  with  Disturbances  of 
Nutrition. — Hypercemia  signifies  superabundance  of  blood  in 
the  blood  vessels,  but  this  term  is  restricted  to  such  a  condi- 
tion existing  in  a  definite  organ  or  portion  of  an  organ  ;  hence 
hypersemia  and  dilatation  of  blood  vessels  are  so  intimately 
connected  that  the  one  cannot  exist  without  the  other. 

It  is  also  necessary  that  the  capillaries  as  well  as  the  arteries 
and  veins  should  be  injected,  in  order  that  the  color  of  the 
region  so  affected  should  be  increased,  as  the  former  consti- 
tute a  dense  network,  which  traverses  the  entire  organ,  while 
the  latter  only  form  single  branches,  which  occupy  limited 
spaces. 

The  term  PletJiora,  as  distinguished  from  hyperaemia,  signi- 
fies a  superabundance  of  blood  in  the  entire  circulatory  system. 
Active  hyperaemia  in  the  skin  and  mucous  membranes  is  char- 
acterized by  a  diffuse  bright-red  coloration,  the  parts  so 
affected  having  a  higher  temperature  than  those  around  them. 
The  diffuse  coloration  is  caused  by  the  bright-red  arterial 
blood  which  fills  the  capillaries  ;  and  the  elevation  of  the  tem- 
perature is  due  to  the  presence  of  the  blood,  which  heats  the 
skin  or  mucous  membranes,  and  the  more  quickly  the  blood 
circulates  the  warmer  the  tissues  become,  until  at  length  the 
highest  degree  of  blood  heat  is  accomplished. 

Passive  hypersemia  denotes  a  condition  of  the  tissues  char- 
acterized by  a  diffuse  venous,  not  arterial,  coloration  and  a 
relatively  low  temperature.  In  passive  hypersemia  the  capil- 
laries are  also  dilated,  but  the  blood  current  through  them  is 
retarded ;  hence  the  tissues  so  affected  are  of  a  venous  color 
instead  of  the  bright-red  or  arterial  color  of  active  hyperaemia. 

The  term  Anaemia  signifies  a  condition  in  which  there  is  an 
abnormal  diminution  in  the  amount  of  blood,  and  is  the  oppo- 
site to  that  of  Plethora,  being  characterized  by  a  pale  face, 
lips,  gums  and  mucous  membranes.  But  the  normal  amount 
of  blood  may  be  present,  and   yet  the   characteristic  paleness 


INFLAMMATION.  19 

denote  an  anaemic  condition,  for  the  reason  that  the  number 
of  red  blood  corpuscles  are  decreased  and  replaced  by  white 
blood  corpuscles,  or  by  blood  plasma. 

Again,  the  paleness  of  an  anaemic  condition  may  be  due  to 
a  deficiency  of  the  red  coloring  matter  of  the  red  blood  cor- 
puscles. A  permanent  contraction  of  the  blood  vessels  may 
also  cause  a  paleness  of  the  face,  lips,  gums  and  mucous 
membranes. 

The  term  Ischcemia  is  also  employed  to  denote  local  pov- 
erty of  the  blood,  a  deficiency  of  the  coloring  matter  (haemo- 
globine). 

The  direct  cause  of  hyperaemia,  and  also  of  ischaemia,  is  a 
change  of  calibre  of  the  blood  vessels,  namely,  dilatation  and 
contraction.  This  dilatation  and  contraction  of  the  blood 
vessels  is  due  to  the  elastic  and  contractile  elements  of  the 
sheaths  and  walls  of  the  arteries  and  veins,  and  both  the  dila- 
tation and  contraction  are  regulated  by  the  spinal  cord, 
through  the  medium  of  the  vaso-motor  nerves.  It  is  a  com- 
mon opinion  that  hyperaemia  cannot  exist  without  the  influence 
of  the  vaso-motor  nerves. 

Irritation  indicates  the  condition  of  a  tissue  in  which  there 
exists  an  excess  of  vital  action,  on  account  of  the  disordered 
state  of  the  nerves  of  the  affected  part  or  organ.  It  is  com- 
monly manifested  by  such  symptoms  as  increased  circulation, 
warmth  and  sensibility,  and  functional  disturbance  of  a  greater 
or  less  degree. 

What  inflammation  is  to  the  vascular  system,  irritation  is  to 
the  nervous  system,  and  the  difference  between  these  two  con- 
ditions is  defined  by  the  explanation  that  the  latter  terminates 
when  the  former  begins.  Irritation  is  generally  excited  by 
the  action  of  certain  stimuli  upon  organic  tissues,  by  which 
the  sensibility  of  such  tissues  is  perverted  and  the  circulation 
deranged ;  such  pathological  conditions  when  they  are  not  the 
precursor  of  inflammation,  soon  passing  off,  and  the  affected 
tissue  regaining  its  normal  state  when  the  exciting  cause 
ceases  to  operate.  Irritation  may  be  direct  and  indirect — 
direct  when  the  irritation  manifests   itself  at   the   point  where 


20  DENTAL  MEDICINE. 


the  impression  to  which  it  owes  its  origin  is  received ;  indirect 
when  the  irritation,  through  sympathy  and  reflex  action,  is 
transmitted  to  more  or  less  remote  parts  or  organs.  An 
example  of  direct  irritation  may  be  adduced  by  friction  upon 
the  skin  or  mucous  membrane  of  the  mouth  sufficient  to 
cause  redness  in  the  first  tissue;  and  increased  coloration  in 
the  second  ;  or  indirect  irritation,  in  the  convulsions  attending 
difficult  dentition,  the  irritation  being  communicated  to  the 
brain  by  the  fifth  pair  of  nerves,  and  from  thence  to  the  nerves 
of  the  voluntary  muscles,  the  seat  of  the  spasmodic  action. 
Dental  caries  also  affords  another  example  of  indirect  irrita- 
tion, in  the  form  of  neuralgic  pains  of  the  temple,  face,  ear, 
eye,  and  of  even  more  remote  parts,  such  as  the  uterus. 

The  effect  of  irritation  upon  the  vascular  system  is  mani- 
fested by  dilatation  of  the  blood  vessels ;  but  the  immediate 
effect,  however,  of  a  slight  chemical  or  mechanical  irritant  is 
not  at  once  apparent  in  the  capillaries,  but  first  causes  contrac- 
tion of  the  smaller  arteries,  and  sometimes  of  the  veins,  such 
contraction  being  followed  by  dilatation,  the  immediate  cause 
of  which  is  yet  obscure.  It  is,  however,  supposed  to  be  the 
result  of  relaxation  or  a  temporary  paralysis  of  the  walls  of 
the  vessels,  a  condition  following  contraction,  and  which,  as  a 
consequence,  causes  a  decrease  of  their  resistance  to  the  pres- 
sure of  the  blood  within  them.  The  irritation  either  perverts 
the  function  of  the  nerves  of  the  vessels,  or  of  the  lining  cell 
substance  of  the  capillary  walls ;  or  the  disturbance  is  due  to 
reflex  action. 

Inflammation  denotes  an  abnormal  process  or  condition 
characterized  by  certain  changes  of  texture,  which,  although 
uniform  in  type,  differ  widely  in  appearance,  and  terminate  in 
different  results,  according  to  the  nature  and  permanency  of 
the  causes  upon  which  such  a  condition  depends,  or  which 
have  given  rise  to  it. 

The  synipioins  of  inflammation  consist  of  the  phenomena 
which  accompany  the  textural  changes  characteristic  of  this 
condition,  and  its  patJiology  the  textural  changes  which  occur 
during    the    continuance    of   this    condition.     The    essential 


INFLAMMATION.  21 


features  of  inflammation  are  an  increased  afflux  of  blood  to  the 
affected  part,  with  a  greatly  increased  tendency  to  cell  prolif- 
eration and  tissue  formation. 

The  caifscs  of  inflammation  determine  in  a  great  degree  its 
treatment  on  account  of  the  influence  they  exert  upon  its 
destructive  tendency,  and  they  may  be  classified  as  those 
arising — ist,  from  mechanical  violence;  2d,  from  irritating  and 
destructive  chemical  action;  3d,  from  poisonous  infection,  and 
the  effect  of  injurious  micro-organisms — the  latter  being 
regarded  as  "  immediate  determining  causes  of  the  more  de- 
structive phases  of  the  inflammatory  process."  When  inflam- 
mation owes  its  origin  to  an  evident  injury,  or  the  reverse,  it 
is  termed  traumatic,  or  idlopatJiic,  and  when  no  apparent  cause 
can  be  discovered  it  is  termed  spontaneous. 

The  causes  of  inflammation  are  divided  into  predisposing 
and  exciting. 

Among  the  more  important  predisposing  causes  are  ini- 
poverished  blood — defective  in  quality — such  as  may  result  from 
a  want  of  proper  food  and  of  fresh  air,  the  effects  of  such  de- 
privations being  manifested  in  the  case  of  a  neglected  child 
where  a  hard  swelling  occurs  in  the  cheek,  which,  after  a  few 
days,  presents  a  gangrenous  condition,  constituting  the  disease 
known  as  cancruni  oris  or  gaugrc^nopsis.  On  the  other  hand 
an  habitual  excess  of  food  and  drink  is  also  a  predisposing 
cause  of  inflammation,  the  blood,  as  a  consequence,  being  im- 
paired, and  also  the  tissue  which  it  supplies.  Blood  poisoning 
is  also  another  predisposing  cause,  resulting,  it  may  be,  from 
the  presence  of  certain  diseases,  such  as  syphilis,  diabetes 
mellitus,  eczema,  etc.  A  local  hyperemia,  constituting  the 
first  stage  in  the  development  of  inflammation,  may  result 
from  certain  poisons  in  the  blood,  which  cause  it  to  stagnate 
in  limited  areas,  through  an  inability  to  stimulate  the  heart 
and  blood  vessels.  Syphilitic  ulceration  of  the  mucous  mem- 
brane of  the  mouth  is  an  example  of  such  a  predisposing 
cause.  Weakened  vitality  of  parts  is  also  a  predisposing  cause 
of  inflammation  and  may  result  from  habitual  ill  feeding,  pro- 
tracted   illness,   over-work,   long  exposure   to  extreme  cold. 


22  DENTAL  MEDICINE. 


Parts  such  as  the  mucous  membrane  of  the  mouth,  which 
have  already  been  the  seat  of  inflammation,  are  prone  to  such 
a  condition  subsequently,  from  slight  provocation. 

Defective  or  perverted  nervous  supply  may  also  be  regarded 
as  a  predisposing  cause  of  inflammation.  Certain  forms  of 
skin  disease,  and  inflammatory  conditions  of  the  mucous 
membrane  of  the  mouth,  furnish  examples ;  also,  of  the  peri- 
dental membrane  of  the  teeth,  resulting  in  severe  periodon- 
titis   and  alveolar  abscess. 

The  infliLence  of  climate  is  also  regarded  as  a  predisposing 
cause,  for,  in  tropical  regions,  inflammation  of  certain  organs, 
often  terminating  in  abscesses,  are  very  prevalent.  The  mid- 
summer and  fall  months  are  considered  to  be  more  favorable 
for  surgical  operations,  on  account  of  the  comparative  absence 
of  inflammatory  complications  at  such  times. 

Age  has  also  some  influence  as  a  predisposing  cause  of 
inflammation.  In  childhood  acute  hyperaemia  is  induced  by 
comparatively  slight  exciting  causes,  as  then  the  process  of 
nutrition  is  at  its  greatest  period  of  activity,  and  any  interrup- 
tion of  its  process  is  followed  by  derangement  of  health. 

The  effects  of  the  irritation  of  the  first  dentition  may  be  ad- 
duced as  an  example.  Old  age  induces  weakness  in  the  tissues 
and  decrease  of  power  of  resistance  to  the  exciting  causes  of 
inflammation. 

Exciting  Causes  of  Inflammation. — These  causes  may  all  be 
included  in  the  condition  known  as  irritation  of  the  tissues, 
resulting  from  irritants  of  various  kinds,  the  action  of  which 
is  immediate  in  producing  the  inflammatory  condition.  Ex- 
citing causes  may  be  divided  into  external,  which  are  easily 
recognized,  and  internal,  which  are  more  obscure,  and  are 
assisted  by  some  predisposition  of  the  organism. 

Cold  is  a  frequent  cause  of  inflammation,  and  its  effects  are 
due  to  sudden  changes  in  the  constitution  of  the  blood  from 
an  arrest  of  the  function  of  the  tissues,  temporary  in  its  nature, 
which  interferes  with  the  emunctory  action,  whereby  effete  and 
irritant  materials  which  should  be  eliminated  are  retained, 
and  poison  the  blood.     Heat  is  also  a  cause  of  inflammation, 


INFLAMMATION.  23 


its  effects  varying  from  a  slight  redness,  denoting  transient 
hyperaemia,  to  vesication,  either  superficial  or  deep.  When 
death  of  tissue  results  from  such  a  cause,  suppuration  ensues 
on  the  separation  of  the  eschar ;  and  when  there  is  a  loss  of 
cicatricial  power,  repair  by  granulation  and  suppuration  (sec- 
ond intention)  is  prevented.  The  inflammation  resulting  from 
simple  burns  and  scalds,  provided  no  eschar  is  formed,  and 
air  is  excluded,  soon  subsides. 

Mechanical  violence  excites  inflammation  ;  yet,  under  favor- 
able circumstances,  this  condition  resulting  from  an  incised 
wound  is  soon  arrested,  owing  to  its  benign  form,  by  the  par- 
ticles of  lacerated  tissue  being  carried  away  by  the  blood  and 
the  subsequent  liquid  exudation,  while  those  that  remain  un- 
dergo liquefaction  and  absorption  by  the  lymphatics ;  hence, 
when  the  cut  surfaces  are  brought  and  retained  in  proper 
apposition,  speedy  union,  by  the  "first  intention','  results. 
Union  by  "first  intention  "  is  induced  by  such  changes  as  cell- 
proliferation,  the  formation  of  new  capillaries,  and  the  genera- 
tion of  cicatricial  tissue.  It  is  only  when  the  vitality  of  the 
tissue  is  destroyed  and  foreign  matters  left  in  the  wound, 
especially  a  punctured  one,  caused  by  a  rough  or  rusty  instru- 
ment, that  there  are  complications.  The  tissues  themselves, 
when  they  lose  their  vitality,  become  irritants,  even  when  the 
dead  matter  is  very  minute.  A  boil  furnishes  an  example, 
the  core  of  which  is  composed  mainly  of  yellow,  elastic  fibres 
with  some  leucocytes  or  pus  cells  in  the  meshes.  This  mass 
becomes  dead,  and  while  the  white  fibrous  element  liquefies 
and  mingles  with  the  pus,  the  yellow  fibres  remain  unchanged 
and  constitute  the  irritant  body,  to  the  presence  of  which  is 
due  the  suppurative  inflammation.  The  presence  of  a  clot  of 
blood  in  a  wound  may  prevent  union,  and  cause  pus  formation. 

Chemical  irritants  excite  inflammation  by  first  causing  in- 
creased redness,  which  steadily  extends  and  becomes  more 
intense  until  a  considerable  diameter  is  attained.  There  is 
also  increased  heat  and  fiiilness  of  the  part  affected,  and  an 
eschar  forms  as  the  result  of  the  action  of  the  chemical  agent 
upon  the  epidermis  in  the  case  of  the  skin,  or  the  corium  in 


24  DENTAL  MEDICINE. 


the  case  of  mucous  membrane,  the  depth  of  the  action  depend- 
ing upon  the  nature  of  the  chemical  irritant.  After  one  or 
two  days  the  narrow  circle  of  redness  disappears,  and,  after 
one  or  two  weeks,  the  eschar  separates,  disclosing  an  area  of 
smooth  cicatricial  tissue.  When  the  action  of  such  irritants  is 
slight,  repair  soon  follows,  without  the  formation  of  an  eschar  ; 
but  when  their  action  is  severe  enough  to  devitalize  the  tissue, 
the  sloughs  are  thrown  off  without  suppuration,  if  the  parts 
have  been  protected  from  the  air,  or  antiseptic  applications 
have  been  made. 

Mineral  irritants,  such  as  mercury  and  arsenic,  for  example, 
cause  inflammation  by  a  process  different  from  that  of  chemi- 
cal irritants.  The  inflammatory  action  of  mercury  and  arse- 
nious  acid  is  developed  only  after  the  poison  has  entered  the 
circulation,  and  a  certain  amount  has  been  received  by  the 
stomach,  when  active  inflammation  of  the  mouth  with  saliva- 
tion (mercurial  stomatitis)  supervenes,  if  the  agent  is  mercury, 
or  active  gastric  hyperemia  with  vomiting,  if  the  agent  is 
arsenic.  There  is  a  specific  poisonous  action  brought  about 
by  such  irritants,  on  account  of  the  tissues  of  the  mouth  and 
stomach  being  more  sensitive  to  the  influence  of  these  mineral 
poisons.  The  cause  of  this  peculiar  susceptibility  is  as  yet 
obscure. 

Micro-organisms  are  capable  of  exciting  inflammation  by 
direct  contact  with  tissues,  when  the  latter  are  exposed  by 
injury. 

Many  of  these  low  forms  of  life  are  indestructible  by  the 
most  extreme  heat  and  cold,  and  also  by  the  strongest  chemi- 
cal agents.  And  whenever  the  oxygen  is  prevented  from 
entering  a  wound  these  micro-organisms  generate  with  great 
rapidity,  and  are  nourished  by  the  fluids  and  granulating  sur- 
faces which  surround  them.  The  chemical  and  vital  changes 
which  these  animal  materials  undergo  bring  about  putrefac- 
tion through  the  agency  of  fermentation,  and  certain  poison- 
ous combinations  are  thus  formed.  These  micro-organisms, 
therefore,  acting  as  a  poison,  decompose  the  materials  gener- 
ated for   repair,  and   thus  prevent   the  constructive  process ; 


INFLAMMATION.  25 


they  also  act  as  a  putrefactive  ferment,  producing  septic  poisons 
destructive  in  their  action.  It  has  been  definitely  determined 
that  these  organisms,  although  present  in  every  destructive 
inflammation,  "  do  not  occur  in  the  blood  nor  in  the  tissues  of 
the  healthy  living  body  of  man  or  of  the  lower  animals." 
Diminished  vitality,  whatever  may  be  the  dause,  favors  the 
invasion  and  development  of  micro-organisms  in  the  form  of 
parasites. 

Symptoms  of  Inflammation.  —  The  coexistence  of  the  phe- 
nomena, redness  and  lieat,  with  sivelling  and  pain,  the  ordinary 
symptoms  of  inflammation,  may,  therefore,  be  considered  as 
sufficient  evidence  of  the  presence  of  the  inflammatory  condi- 
tion. The  absence,  however,  of  one  or  more  of  these  phe- 
nomena is  not  incompatible  with  the  existence  of  inflammation, 
for  the  increased  redness  and  heat  may  disappear  before  the 
inflammatory  process  ceases,  and  pain  be  sometimes  absent. 

The  redness  of  an  inflamed  part  is  usually  the  first  observ- 
able phenomenon,  and  one  of  the  most  characteristic  symptoms 
of  inflammation,  and  one  also  that  is  rarely  absent.  It  varies 
in  intensity,  according  to  the  degree  of  the  inflammatory 
process,  the  nature  of  the  part  affected,  the  condition  of  the 
system,  and  the  cause  of  the  inflammation.  Of  a  light  tint  in 
the  early  stage,  it  becomes  deeper  as  the  inflammatory  process 
increases  in  degree,  until  every  grade,  almost,  of  redness  is 
observable,  ending  in  a  deep  crimson  or  even  purple.  It  may 
appear  in  points,  streaks,  in  minute  ramifications,  or  be  quite 
uniform  over  the  entire  surface  affected.  Usually  it  is  more 
intense  in  one  spot,  gradually  fading  as  it  recedes,  until  lost  in 
the  surrounding  healthy  tissue;  in  other  cases  the  redness  has 
an  abrupt  boundary,  and  is  of  equal  intensity  over  its  entire 
area.  The  brighter  -hue  usually  attends  ordinary  active  in- 
flammation ;  the  darker  hue  that  form  of  inflammation  pro- 
ceeding from  some  specific  cause,  or  associated  with  a  gangre- 
nous tendency.  The  redness  of  inflammation  is  caused  by  the 
increased  amount  of  blood  entering  the  vessels  of  the  part, 
and  remaining  there  for  a  longer  time  than  is  natural  under 
other  conditions. 


26  DENTAL  MEDICINE. 


The  Heat  of  an  inflamed  part  is  also  caused  by  the  unusual 
quantity  of  red  blood  present,  and  also  by  an  increase  of  that 
vital  action  upon  which  the  evolution  of  heat  depends,  namely, 
superoxidation  of  the  affected  tissues,  resulting  in  their  de- 
composition. The  increase  of  temperature  is  generally  more 
sensible  to  the  Sufferer  than  to  the  observer,  though  it  may 
often  be  detected  by  the  hand,  and  is  very  evident  by  the 
clinical  use  of  the  thermometer  ;  it  is  also  verified  by  compari- 
son with  other  unaffected  parts. 

The  Szvelling  of  an  inflamed  tissue  is  caused  in  part  by  the 
unusual  quantity  of  blood  present  in  the  dilated  vessels,  and 
also  by  the  matters,  both  Hquid  and  solid,  which  exude  into 
the  affected  tissue  through  the  walls  of  the  dilated  vessels,  and 
also  to  extravasation  resulting  from  rupture  of  these  walls  ;  for 
as  the  vessels  are  distended  their  walls  become  thinner,  and 
permit  the  blood  plasma  to  escape  through  them  in  greater 
quantity  than  is  required  for  mere  nourishment;  hence  the 
inflamed  tissue  becomes  infiltrated  with  this  plasma,  the  con- 
sequence of  which  is  an  increase  of  thickness  or  swelling. 
The  swelling  of  a  part,  however,  without  other  symptoms  is 
not  an  evidence  of  inflammation,  as  this  phenomenon  may 
occur  from  other  causes.  Swelling  may  also  be  absent  when 
the  other  symptoms  of  inflammation  are  present,  an  example 
of  which  is  afforded  in  inflammation  of  mucous  membranes, 
before  exudation  has  occurred  in  the  connective  tissue  be- 
neath. 

The  Pain  of  inflammation  is  due  to  the  local  irritation  of 
nerves  of  the  part,  caused  by  the  irritant  which  has  excited 
the  condition  ;  also  by  the  tension  which  results,  together 
with  the  injury  inflicted  upon  the  nervous  filaments.  Every 
tissue  is  supplied  with  sensory  nerves,  and  the  pain  resulting 
from  irritation  and  injury  varies  considerably,  in  accordance 
with  the  nature  of  the  part  and  its  supply  of  nervous  filaments. 
Parts  having  little  sensibility  in  a  normal  condition,  often 
become  extremely  painful  when  inflamed ;  the  gums  afford  a 
well  marked  example.  When  the  parts  are  unyielding,  as  in 
periodontitis,    the  pain    becomes  very  severe ;    and  a  pulsa- 


INFLAMMATION.  27 


ting  or  throbbing  pain  is  caused  by  the  increased  force  of  the 
smaller  vessels  conveying  the  blood  to  the  focus  of  inflamma- 
tion, and  also  the  obstruction  of  the  circulation  produced  by 
the  swelling  and  increased  by  the  stasis  at  the  focus  of 
the  affected  area.  When  the  veins  of  an  inflamed  part  be- 
come obstructed  by  the  swelling,  bringing  about  pressure  to 
such  a  degree  as  to  prevent  the  blood  from  passing  through 
them,  the  quantity  being  constantly  increased  by  the  supply 
from  the  arteries,  a  condition  of  strangulation  results,  in  which 
the  pain  is  very  severe. 

We  find  an  example  of  this  condition  of  strangulation  in 
pulpitis,  or  inflammation  of  the  pulps  of  the  teeth.  Pain  is 
also  generally  present,  even  in  the  case  of  soft  tissues  affected 
with  inflammation,  and  where  every  advantage  is  afforded  for 
their  swelling;  the  oral  mucous  membrane  is  an  example. 
There  is  also  pain  of  an  itching  character,  in  certain  forms  of 
inflammation  of  mucous  membranes ;  also  boring  pain  in  the 
neighborhood  of  joints.  The  pain  of  alveolar  abscesses,  when 
they  slowly  form,  is  often  of  a  tensive  character,  and  generally 
becomes  lancinating  when  they  are  about  to  point ;  and  in  all 
such  cases  is  useful  in  determining  the  seat  of  the  suppur- 
ative process. 

Fever  of  Inflannnation,  also  known  as  "traumatic,"  is  very 
generally  present  when  the  inflammation  is  severe,  or  the 
injury  occasioning  it  is  extensive  and  complicated.  This 
inflammatory  fever  generally  makes  its  appearance  in  from 
twelve  to  twenty-four  hours  after  the  injury  is  received,  or 
when  the  inflammatory  process  is  at  its  height ;  and  when  the 
parts  have  previously  been  healthy,  and  the  inflammation 
limited,  it  is  moderate  in  its  character  and  soon  terminates 
spontaneously.  The  symptoms  of  inflammatory  fever  are  a 
feeling  of  fatigue,  restlessness,  thirst,  hot  and  dry  mouth, 
coated  tongue,  urine  scanty,  but  deeper  in  color,  frequent  pulse, 
temperature  about  ioo°  F. ;  and  the  fever  usually  reaches 
its  climax  in  about  thirty-six  hours,  when  it  begins  to  decline, 
and  by  the  sixth  or  seventh  day  has  disappeared.  In  the  case 
of  an   abscess,  it  frequently  happens  that  when  suppuration 


28  DENTAL  MEDICINE. 


occurs  the  fever  begins  to  decline.  Should  the  fever  continue 
longer  than  the  time  referred  to,  the  cause  may  generally  be 
due  to  deeper  suppuration  and  other  complications  of  the 
local  affection.  During  the  inflammatory  process,  when 
putrescent  matter  has  been  absorbed  by  the  blood  in  greater 
quantity  than  can  be  resisted  or  gotten  rid  of  by  the  organism, 
and  there  is  no  escape  from  it  by  drainage,  the  symptoms  of 
inflammatory  fever  become  more  intense,  and  a  condition  of 
septic  poisoning  takes  place,  known  as  sepiiccemia.  When 
some  time  has  elapsed  after  the  inception  of  the  inflammatory 
process,  and  the  characteristic  fever  has  almost  disappeared,  a 
chill  suddenly  occurs,  followed  by  profuse  perspiration,  the  con- 
dition known  as  pycEinia  is  present — pus  globules  in  the  blood. 
Exudation. — The  exudation  of  materials,  such  as  a  phosphatic 
saline  fluid,  and  white  blood  corpuscles  and  fibrin,  through 
the  capillary  vessels,  is  due  to  inflammation,  and  such  exuda- 
tions are  derived  from  the  blood.  The  symptom  of  swelling 
is  in  great  part  due  to  exudation.  The  exudation  in  what 
is  termed  "  healthy  inflammation,"  and  known  as  plastic  or 
coagulable  lympli,  seen  on  the  surface  of  a  recent  wound  or  in 
the  form  of  swelling  around  a  centre  of  inflammation,  is  a  mild 
and  unirritating  product,  the  function  of  which  is  to  form 
new  tissues  for  repair,  called  at  first  granulations.  Inflam- 
matory exudations  from  free  surfaces  of  mucous  membranes 
contain  mucus,  and  a  substance  known  as  -mucin,  in  the  form 
of  filaments,  insoluble  in  acetic  acid.  The  inflammator}^  effu- 
sion known  as  plastic  or  coagulable  lymph,  the  true  indicator  of 
a  healthy  constructive  process,  is  soon  converted  from  a  jelly- 
like substance,  by  the  germinal  power,  into  a  mass  of  living 
cells,  through  which  other  minute  cells,  which  are  to  form  the 
capillaries,  make  their  way  like  a  small  stream,  the  primitive 
living  cells  flattening  out,  and  making  walls,  apparently,  for 
the  forming  vessels.  These  new  capillaries  penetrate  the  mass 
of  germinal  cells  in  large  numbers,  like  delicate  connecting 
threads,  and  furnish  the  blood  supply  to  the  organizing  mass, 
which  becomes  converted  into  nezv  or  young  connective  tissue. 
This  tissue  drawing  and  binding  together  the  opposite  sides  of 


INFLAMMATION.  29 

the  wound  then  becomes  the  cicatricial  tissue,  which  originates 
from  the  cement-hke  material  furnished  by  the  inflammatory 
exudation.  The  cicatricial  tissue  becomes  invested,  in  the 
case  of  oral  mucous  membrane,  with  epithelium,  by  a  similar 
process  of  cell  growth  and  development ;  and  this  is  the  pro- 
cess of  union  by  the  first  intention.  The  cicatrix  or  scar  is 
redder  than  natural,  owing  to  the  large  number  of  vessels  ; 
but  when  the  supply  of  blood  is  no  longer  needed  in  such 
quantity  as  is  at  first  necessary,  the  capillaries  diminish  and 
disappear,  so  that  the  cicatrix  grows  paler  and  of  smaller  bulk. 
In  the  case  of  an  abrasion  of  the  skin,  the  exuding  plastic 
lymph  dries  upon  the  denuded  surface  when  not  disturbed, 
and  forms  a  protecting  crust,  which  at  length  falls  off,  exposing 
a  reddish  surface  covered  with  epidermis.  In  the  case  of  the 
oral  mucous  membrane,  a  like  result  is  produced  under  the 
protection  of  the  mucous  secretions  peculiar  to  such  a  tissue. 
Suppuration. — The  formation  of  pus  is  a  result  of  destructive 
inflammation,  as  the  presence  of  such  a  fluid  denotes  a  loss  of 
substance,  which  does  not  occur  when  a  wound  heals  by  tlie 
first  iiitentiofi.  Under  favorable  circumstances  an  inflamed 
surface  heals  by  the  process  oi  tlie  secoiid  intention,  as  follows  : 
A  soft,  red  surface  of  coagulable  lymph  becomes  organized 
into  embryonic  tissue,  which  is  known  as  grannlatian  tissue, 
and  the  yellowish  fluid,  bland  in  nature,  which  is  present,  is 
pus;  these  materials  or  "products  of  inflammation"  being 
generated  for  reparative  processes.  The  granulation  tissue  is 
composed  of  embryonic  cells  and  a  network  of  capillary  loops, 
by  which  the  tissue  receives  its  supph'  of  nutritive  matter 
from  the  blood,  so  that  it  may  become  what  is  recognized 
later  as  the  cicatrical  tissue,  or  one  of  a  higher  organism  than 
the  granulation  tissue.  The  granulation  tissue  is  of  a  variable 
pinkish  color,  the  tint  depending  upon  the  quality  of  the  blood 
which  its  vessels  contain,  and  is  of  a  jelly-like  consistence,  and 
somewhat  smooth  and  firm.  Its  surface,  when  in  a  normal 
condition,  is  studded  over  with  small  conical  prominences 
called  granulations,  in  which  are  very  minute  vessels  situated 
so  superficially  as  to  bleed  on  the  slightest  touch. 


30  DENTAL  MEDICINE. 

Pus  of  a  yellow  color  is  found  between  the  granulations, 
which  vary  in  size,  form  and  color,  a  moderate  bright-red 
color  being  indicative  of  a  healthy  healing  process. 

When  there  is  a  want  of  power  in  the  process  of  forming 
the  cicatricial  or  repair  tissue,  the  granulations  become  large 
and  translucent,  and  the  pus  which  surrounds  them  is  pale  and 
thin.  If  the  affected  surface  is  exposed  to  friction,  or  irritation 
from  other  causes,  the  granulations  become  extremely  small 
and  of  a  deeper  red  color  than  is  normal,  and  at  length  may 
disappear  at  points,  leaving  grayish  spots  or  smooth  patches. 
If  the  process  of  cicatrization  is  prevented  in  its  first  stage,  the 
granulations  become  large  and  coalesce,  protruding  and  over- 
hanging the  edges  of  the  wound,  and  forming  what  is  com- 
monly known  as  "proud  flesh."  During  the  entire  healing 
process  a  flow  of  pus  is  going  on  from  the  affected  surface  as 
a  normal  act,  and  the  first  appearance  of  it  is  indicative  of 
repair.  Its  appearance  is  also  coincident  with  the  organization 
of  plastic  lymph.  When  the  suppuration  is  well  established, 
the  heat,  tension  and  swelling  of  the  inflamed  part  becomes 
less  in  degree,  and  the  frequency  of  the  pulse  and  the  tem- 
perature of  the  body  diminish.  Whenever  the  granulating 
surface  is  formed,  union  by  the  second  intention,  or  second 
adhesion,  d.?,  it  is  termed,  will  take  place,  if  separated  surfaces 
are  brought  into  apposition. 

Origin  and  Characteristics  of  Pus. — Pus  is  a  secretion  fur- 
nished by  the  blood  at  the  expense  of  the  tissues,  an  exuberant 
quantity  of  plastic  material,  for  which  excess  there  is  no 
demand  in  the  reparative  process.  The  leucocytes  which  are 
brought  to  the  surface  of  a  granulating  wound  are  discharged 
from  it  in  the  form  of  pus,  while  those  that  remain  behind 
develop  into  tissue.  This  effect,  by  which  the  excess  of  leu- 
cocytes is  gotten  rid  of,  is  accomplished  by  liquid  exudation, 
the  supply  of  which  comes  from  the  newly  formed  and  the 
old  capillaries,  and  is  the  same  force  that  carries  the  nutritive 
material  to  the  tissues.  Healthy  pus  is  of  a  yellowish-white 
color,  sometimes  assuming  a  pale  greenish  tint,  of  cream-like 
consistence;    a   slightly  saltish  taste,  but  somewhat  sweet;  a 


INFLAMMATIOJS.  31 

faint  animal  odor,  with  an  alkaline  reaction.  The  presence  of 
bile  may  give  to  pus  a  deep  orange  color,  while  all  of  the 
other  shades  are  due  to  the  coloring  matter  of  the  blood, 
known  as  haematoidin.  As  long  as  the  air  has  access  to  it, 
there  is  little  tendency  to  putrefaction ;  and  even  when  it  is 
removed  from  the  body  and  exposed  to  ordinary  temperature, 
change  in  it  occurs  very  slowly.  Pus  consists  of  two  portions 
— a  solid  portion,  known  2JS,  pus  corpuscles,  and  which  consists 
almost  entirely  of  young  pus  cells  or  leucocytes,  and  a  liquid 
portion  known  as  liquor  picris,  which  is  a  serous  fluid,  and 
constitutes  about  three-fourths  of  its  bulk. 

When  pus  is  subjected  to  pressure,  as  sometimes  occurs  in 
abscess  of  the  antrum,  and  about  bones,  it  may  become  a  yel- 
lowish, cheesy  mass,  owing  to  the  compression  of  the  pus 
cells.  The  solid  portion  of  pus  consists  of  more  than  nine- 
tenths  of  leucocytes  or  young  pus  cells,  which,  in  freshly 
formed  pus,  presents  under  the  microscope  a  granular  appear- 
ance, and  also  the  peculiar  movements  of  active,  young  and 
healthy  leucocytes  ;  but  pus  which  has  collected  in  an  abscess 
for  several  days  shows  no  such  movements,  thereby  indicating 
that  the  leucocytes  have  died.  Living  and  dead  pus  cells  may 
be  found  in  ordinary  pus,  mingled  together.  Pus  also  con- 
tains such  micro-organisms  as  vibrios  and  bacteria. 

Varieties  of  Pus. — The  constitution  of  pus,  which  is  subject 
to  constant  change,  depends  upon  the  form  of  the  disease,  the 
locality,  and  the  condition  of  the  patient.  When  it  is  of  a 
yellowish-white  color,  of  the  consistence  of  cream,  and  com- 
posed of  a  great  number  of  pus  globules,  it  is  called  "healthy," 
"pure,"  or  "laudable."  '' Sanious,"  "  serous,"  and  "  ichorous  " 
pus  is  almost  transparent,  of  a  yellowish,  oily,  or  reddish 
color,  and  very  acrid,  being  the  product  of  unhealthy  inflam- 
mation, and  is  common  to  caries  of  the  bones,  irritable  ulcers, 
etc.,  and  frequently  mixed  with  blood,  particles  of  fibrin,  and 
dead  tissue.  In  chronic  and  cold  abscesses  the  pus  corpuscles 
become  pale  and  watery,  showing  that  they  are  undergoing 
solution ;  the  pus  from  epithelial  tumors,  indolent  ulcers,  and 
phagedenic  ulcers,  is  thin  and  sanious,  and  contains  more  or 
less  dead  tissue,  which  prevents  the  repair. 


32  DENTAL  MEDICINE. 


The  term  abscess  denotes  a  collection  of  pus  in  the  substance 
of  the  tissues,  and  the  formation  of  the  acute  form  is  as  follows  : 
The  exciting  cause,  acting  as  an  irritant,  causes  an  afflux  of 
blood  to  the  centre  of  the  affection,  and  the  distended  capilla- 
ries pour  out  liquid  exudation,  which  coagulates  at  this  cen- 
tre into  plastic  lymph,  expanding  the  meshes  of  the  neighbor- 
ing surrounding  tissues  with  a  more  serous  fluid. 

Leucocytes  are  formed  from  cell  proliferation  in  the  plastic 
lymph ;  but,  on  account  of  their  not  being  in  a  proper  place 
for  their  growth  and  development  into  tissue,  they  become 
changed  into  pus,  which  collects  in  a  cavity  formed  by  it,  and 
the  result  is  an  abscess.  As  these  phenomena  occur  in  rather 
quick  succession,  pain,  heat,  redness  and  swelling  are  present, 
and  also  constitutional  disturbance  in  the  form  of  hectic  fever. 

The  increase  of  an  abscess  in  size  is  attended  with  a  certain 
amount  of  redness  on  the  surface  over  it  and  to  which  it  is 
approaching,  this  increasing  redness  being  preceded  by  rriore 
or  less  oedema  of  the  tissue  beneath,  which  is  owing  to  the 
protruding  of  the  serous  exudation  surrounding  the  central 
collection  of  pus.  The  centre  of  the  surface  redness  then 
presents  a  more  prominent  and  elevated  point,  where  the  outer 
tissue  becomes  thinner,  purplish,  or  livid,  and  soon  the  yellow 
pus  within  is  visible  through  it — a  condition  to  which  the 
term /t^/w//;/^  is  applied.  Soon  after  the  "  pointing,"  the  in- 
tegument gives  way,  and  the  pus  exudes  through  the  opening 
thus  made. 

This  thinning  and  weakening  of  the  surface  is  caused  by 
the  stretching  and  obstruction  of  the  blood  vessels,  which 
convey  the  nutritive  supply  from  beneath,  by  the  pressure  of 
the  enlarging  abscess  to  such  a  degree  that  the  surface  integu- 
ment is  deprived  of  its  blood  and  slowly  dies  by  minute  par- 
ticles, the  dead  material  being  added  to  the  contents  of  the 
abscess. 

An  abscess  unattended  with  such  symptoms  as  pain,  heat, 
and  redness,  is  termed  a  cold  abscess,  and  its  presence  depends 
upon  a  low  degree  of  vitality. 

A  cold  abscess  presents  the  same  phenomena  of  pus  forma- 


INFLAMMATION.  33 


tion  as  the  acute  form,  but  resembles  more  the  growth  of  a 
tumor,  as  all  the  symptoms  maybe  absent  except  the  swelling. 
The  formation  of  pus  on  the  surface  of  a  tissue,  such  as  mu- 
cous membrane,  is  not  so  serious  as  that  in  an  abscess,  as  the 
conversion  of  the  leucocytes  into  pus  requires  but  little  more 
increased  activity  than  in  cell  germination.  The  exudation 
takes  place  from  the  network  of  capillaries  which  exist  beneath 
every  mucous  membrane,  and  which  furnishes  nourishment 
for  the  constant  renewal  of  the  epithelium,  and  any  injury 
received  causes  a  fluxion  of  blood  to  the  capillaries,  which 
increases  the  cell  proliferation.  The  effect  is,  then,  to  promote 
an  increased  discharge  from  the  surface  of  the  membrane,  in 
the  form  of  pus.  Suppuration  from  mucous  membrane  usu- 
ally causes  pain,  heat,  increased  redness,  and  swelling  of  the 
inflamed  surface,  owing  to  the  exudation  into  the  meshes  of 
the  connective  tissue  beneath,  and  recovery  is  characterized 
by  diminished  fluxion  of  blood  to  the  affected  part,  and  conse- 
quent lessening  of  cell  production  ;  the  cells  resume  their 
function  of  producing  epithelial  tissue,  the  pus  becomes  thin 
and  more  fluid,  and  finally  ceases  when  the  normal  conditions 
again  appear. 

Hectic  fever  is  a  symptom  of  destructive  inflammation,  and 
is  a  persistent,  low  form  of  continued  fever,  characterized  by 
remission  and  exacerbation  morning  and  night.  This  form  of 
fever  is  caused  by  absorption  into  the  blood  of  some  of  the 
products  of  inflammation,  in  such  quantities  and  so  gradually 
as  not  to  produce  an  immediate  fatal  result,  and  inducing  a 
regular  succession  of  chill,  fever,  and  perspiration  during  the 
space  of  every  twenty-four  hours.  Its  effect  is  progressive 
emaciation  and  a  tendency  to  fatal  termination,  if  the  cause  is 
not  removed,  through  combustion  of  tissue  material  to  supply 
the  fever  heat.  The  regularity  of  the  night  sweats,  and  the 
pulse  retaining  its  frequency  during  the  apyrexia,  even  in  the 
morning,  when  the  temperature  is  normal,  are  the  diagnostic 
signs  of  hectic  from  typhoid  and  malarial  fevers. 

The    most   unfavorable    symptoms   of  hectic  fever  are  the 
higher   fever  in  the  evening,  the   increase  in  the  frequency  of 
3 


DENTAL  MEDICINE. 


the  pulse,  the  more  exhausting  night  sweats,  with  the  occur- 
rence of  aphthae  in  the  mouth,  and  diarrhoea. 

Chronic  Inflammation. — Chronic  or  asthenic  inflammation 
is  a  process  in  which  all  the  cardinal  symptoms  of  inflamma- 
tion may  be  present,  but  in  less  degree  than  in  the  acute 
form.  In  chronic  inflammation  there  is  present  a  permanent 
local  hyperaemia,  attended  with  an  exudation  into  the  inter- 
stices of  the  inflamed  part,  or  from  its  surface.  The  pain  in 
this  form  is  usually  light,  or  may  be  intermittent,  or  even 
absent,  or  be  no  more  than  an  itching  sensation  ;  heat  is 
present,  but  is  not  a  prominent  symptom ;  the  redness  is  of  a 
light  hue,  sometimes  livid,  from  passive  hyperaemia  and  the 
stretching  of  the  vessels  by  the  over-distention  to  which  they 
had  before  been  subjected,  and  the  diminished  force  of  the 
circulation ;  the  swelling  is  in  the  form  of  induration,  owing 
to  the  exudation  having  become  organized  into  tissue.  This 
latter  accounts  for  the  hardness  around  an  indolent  ulcer,  and 
an  old  sinus.  Inflammatory  induration  consists  of  the  new 
tissue  growth  in  the  state  of  more  imperfect  organization  than 
the  normal  cicatricial  tissue.  In  mucous  membranes  indura-. 
tion  is  indicative  of  chronic  inflammation,  and  is  caused  by 
exudative  infiltration  into  the  substance  of  the  submucous  con- 
nective tissue,  and  a  considerable  change  of  structure  in  these 
membranes  often  occurs.  Although  the  symptoms  of  chronic 
inflammation  are  present  in  a  limited  degree,  yet  they  are  more 
persistent,  on  account  of  the  object  for  which  the  increased 
nutritive  effort  was  made  proving  unsuccessful. 

Ulceration  '  is  a  passive  process,  and  results  from  the 
molecular  death  caused  by  insufficient  blood  supply,  insufii- 
cient  nervous  influence,  impure  quality  of  blood,  or  the 
presence  of  blood  poison.  Ulceration  is  very  closely  associ- 
ated with  inflammation,  although  the  former  may  be  independ- 
ent of  the  latter,  and  consists  of  a  progressive  softening  and 
disintegration  of  successive  layers  of  the  affected  tissue. 
Ulceration  generally  begins  in  a  process  of  chronic  inflamma- 
tion, and  in  such  a  manner  that  the  death  of  the  tissues  only 
occurs  when  the  tissues  themselves  have  undergone  cellula 


INFLAMMATION.  35 


infiltration  in  consequence  of  the  inflammatory  changes.  The 
loss  of  the  integument  leaves  a  red,  raw  surface,  which  bleeds 
easily,  and  which  is  covered  with  a  tenacious,  slimy  matter. 
Very  soon  irregular  cavities  are  formed  in  this  surface,  sepa- 
rated by  red  elevations  with  ragged  edges.  A  thin,  serous, 
bloody  discharge  exudes,  with  severe  pain  of  a  gnawing  char- 
acter. The  ulcer  then  formed,  and  which  has  been  defined  as 
"  a  wound  surface  having  no  tendency  to  heal,"  spreads  more 
or  less  rapidly,  and  the  surrounding  integument  is  hot  and 
swollen,  and  the  disintegrated  tissue  is  thrown  off  as  extra- 
neous matter.  Ulcers  also  originate  from  pustules  that  fail  to 
heal  after  the  pus  escapes,  but  spread  and  maintain  an  acute 
inflammatory  character.  An  ulcer  may  be  circular,  crescentic, 
irregular,  in  the  form  of  a  shallow  or  deep  ring,  or  it  may  be 
tubular,  forming  a  fistula. 

The  edges  of  an  ulcer  are  either  low  or  raised,  hard  (callous), 
soft,  jagged,  vertical,  everted,  or  undermined,  etc.  Ulcers 
arising  from  persistent  local  irritation,  as  those  of  the  oral 
mucous  membrane,  usually  heal  as  soon  as  the  affected  parts 
are  placed  under  favorable  external  circumstances.  As  long 
as  the  epithelium  is  preserved,  the  superficial  inflammatory 
process  in  mucous  membranes  may  be  called  catarrh.  When 
suppuration  of  mucous  membranes  proceeds  so  far  as  to  expose 
\^\&  substantia  propria  or  corium,  the  diseased  surface  is  known 
as  an  ulcer. 

Effects  of  Micro-Organisms. — While  some  of  the  common 
parasites  cause  injurious  effects  by  inciting  inflammation  in 
tissues  and  organs,  they  only  act  as  foreign  bodies,  while  the 
microscopic  fungi  and  their  germs,  acting  as  invisible  particles 
of  organized  matter,  cause  the  greatest  injury.  If  they  are 
protected  from  the  influence  of  oxygen,  these  micro-organisms 
germinate  very  rapidly,  and  derive  their  sustenance  from  the 
fluids  of  the  inflamed  tissue  and  the  granulating  surface.  The 
form  known  as  vibrio  septica  generate  putrefaction  in  animal 
matter  by  bringing  about  a  process  of  fermentation — dental 
caries  affords  an  example.  The  chemico-vital  changes  accom- 
panying the  process    of  putrefactive   fermentation    give    rise 


36  DENTAL  MEDICINE. 


to  septic  poisons,  which,  being  absorbed  in  the  circulation, 
result  in  septiccemia  and  pycEviia.  Dr.  Koch  affirms  that 
"bacteria  do  not  occur  in  the  blood  nor  in  the  tissues  of  the 
healthy  living  body,  either  of  man  or  of  the  lower  animals," 
and  the  same  investigator  also  says  :  "  When  introduced  by 
inoculation  into  animal  tissues,  they  multiply  and  excrete 
soluble  substances,  which  get  into  the  surrounding  tissues  by 
diffusion." 

The  tissues,  by  the  contact  of  the  micrococci,  lose  their 
vitality,  and  the  parasite  growth  multiplies  and  spreads  rapidly 
in  the  dead  tissues,  advancing  directly  toward  the  parts  in 
which  vitality  yet  remains. 

Terviinations  of  Inflaiinuation. — According  to  the  present 
knowledge  of  this  subject,  inflammation  terminates — ist,  By 
Resolution;  2d,  By  Suppuration. ;  3d,  By  Fonnatioii  of  New 
Tissue;  4th,  By  Gangrene  ox  Local  Death — Necrosis.  When 
the  inflammatory  process  terminates  by  resobition,  all  of  the 
symptoms  gradually  diminish  and  disappear,  and  the  affected 
tissues  resume  their  normal  condition.  Such  a  result  is  gen- 
erally due  to  the  mild  character  of  the  injury,  and  the  progress 
of  the  inflammation. 

When  the  inflanimatory  process  terminates  by  suppuration, 
there  is  a  loss  of  substance,  and  after  the  discharge  of  the  pus, 
a  more  extensive  process  of  repair  is  required  to  produce  a 
healing  of  the  wound  and  the  formation  of  the  cicatrix." 

When  the  inflammatory  process  terminates  by  th.Q  formation 
of  new  tissue,  the  new  growth  is  produced  by  inflammation — 
either  by  the  union  by  first  intention,  or  by  the  development 
of  granulations,  which  become  organized  into  a  cicatrix. 

When  the  inflammatory  process  terminates  in  gangrene  or 
local  death,  the  effort  of  the  inflammation  toward  repair  has 
failed,  either  on  account  of  the  functions  of  the  capillaries  and 
the  connective  tissue  becoming  impeded  to  such  a  degree  as  to 
render  inoperative  the  resources  of  the  organisms,  or  because 
of  certain  conditions  arising  at  a  later  period  which  have 
obstructed  the  reparative  effort  and  caused  the  parts  to  lose 
their  vitality. 


INFLAMMATION.  .  37 


The  termination  of  the  inflammatory  process  by  gangrene 
depends  upon  the  degree  and  nature  of  the  lesion,  and  the 
inabihty  of  the  capillaries  and  arteries  to  maintain  the  local 
circulation.  The  impairment  of  the  vitality  of  the  blood  ves- 
sels causes  stasis  and  thrombosis  to  occur,  and  as  soon  as 
actual  death  takes  place,  the  dead  tissue  presents  a  further 
obstacle  to  the  local  circulation,  and  also  adds  to  the  difficulty 
of  elimination,  which  favors  the  spread  of  the  gangrene.  The 
earliest  symptoms  of  gangrene  are  hard  swelling,  burning  and 
tensive  pain,  and  livid  color.  The  pain  then  subsides,  vesica- 
tions appear,  the  part  takes  on  a  marbled,  purplish-yellow 
color,  afterward  becoming  brown  or  grayish,  and  finally  cold 
and  insensible,  exhaling  a  putrid  odor. 

Treatment  of  Inflammation. — It  has  already  been  stated 
that  the  causes  of  inflammation  determine  in  a  great  measure 
its  treatment,  and  this  is  especially  true  of  inflammation  of  the 
oral  mucous  membrane.  The  old  method  of  antiphlogistic 
treatment  has  given  place  to  antiseptic  treatment,  although 
some  of  the  older  measures  are  still  employed,  and  may  occa- 
sionally be  used  to  advantage  in  relieving  certain  symptoms  of 
inflammation,  and,  without  removing  the  cause,  favoring  a 
return  to  the  normal  condition.  The  indications  of  treatment 
are  as  follows : 

Prevention  and  Removal  of  Cause. — Prevention  may  include 
the  remov^al  of  a  predisposing  cause  when  local,  or  the  lessen- 
ing of  its  effects  when  it  is  general  or  constitutional.  If  mala- 
ria is  present,  quinine  is  indicated;  if  syphilis,  iodide  of  potas- 
sium, or  minute  doses  of  bichloride  of  mercury. 

Irritation,  the  precursor  of  inflammation,  may  often  be 
arrested  by  the  removal  of  a  local  cause,  such  as  salivary  calcu- 
lus, for  example.  The  restoration  of  the  secretion  of  the 
different  organs  is  also  indicated  in  the  treatment  of  certain 
forms  of  inflammation,  and  also  the  use  of  such  palliative 
remedies  as  will  allay  the  excitement  of  the  nervous  system. 
When  the  cause  is  apparent,  its  removal  is,  as  a  general  rule, 
easily  accomplished;  but  when  the  cause  is  obscure,  the  con- 
dition of  the  secretions  of  the  bowels  ^nd    the   diet    should 


38  DENTAL  MEDICINE. 


receive  careful  attention.  To  correct  the  secretions,  purgatives 
are  indispensable;  also  such  other  depletory  measures  as 
bleeding,  abstinence  from  food,  use  of  emetics  or  nauseants  to 
lessen  the  general  circulation  and  reduce  the  vascular  tension. 
To  allay  the  nervous  excitement  and  irritability,  anodynes, 
narcotics  or  opiates  are  indicated,  their  direct  effect  being  relief 
of  pain  and  spasm,  and  inducement  to  rest  and  tranquillity. 

The  advantage  of  rest  and  immobility  cannot  be  over-esti- 
mated, for  a  simple  lesion,  if  subjected  to  constant  mobility, 
may  become  one  of  a  much  greater  character,  destructive 
inflammation  often  being  provoked  by  friction  and  undue 
motion.  An  example  is  furnished  in  the  case  of  periodon- 
titis, where  a  cap  or  partial  interdental  splint  made  of  model- 
ing composition  or  gutta  percha,  or  vulcanized  rubber,  will 
protect  the  affected  tooth  from  irritation,  and  materially  assist 
the  remedial  measures;  also  strips  of  adhesive  plaster,  collo- 
dion, etc.,  will  insure  immobility  in  certain  cases  where  such 
appliances  are  indicated,  as  undue  motion  retards  and  prevents 
the  process  of  healing. 

Position  is  also  to  be  considered  as  a  means  for  relieving 
the  irritation  and  pain,  so  that  no  provocation  may  exist  for 
subsequent  inflammation.  The  best  position  should  be  selected 
for  the  affected  part,  which  will  favor  the  return  of  venous 
blood  and  retard  the  arterial  current;  hence,  an  elevated  posi- 
tion will  tend  to  prevent  passive  hyperaemia.  A  favorable 
position  will  also  secure  muscular  relaxation,  and  prevent  the 
involuntary  spasmodic  action,  which  may  result  from  muscular 
tension.  The  administration  of  an  anaesthetic  to  secure  mus- 
cular relaxation,  in  the  case  of  certain  injuries,  as  in  fracture 
or  dislocation  of  the  jaw,  is  often  resorted  to  as  a  measure 
against  spasmodic  contraction,  and  also  to  reduce  the  excessive 
vascular  reaction. 

Cold,  when  outwardly  applied  as  a  depressor  to  the  inflamed 
part,  reduces  the  excitement  and  irritability  The  application 
of  the  spray  of  absolute  ether,  or  of  rhigolene,  will  often 
prove  servicable  in  the  early  stage  of  periodontitis.  Cold, 
whenever  moderately  applied,  is  tonic  and  invigorating,  and 


INFLAMMATION.  39 


besides  evaporating  applications,  ice  may  be  employed  ;  but 
such  local  measures  to  maintain  a  low  temperature  must  be  re- 
newed at  short  intervals.  Cold,  when  locally  applied,  causes 
the  capillaries  to  contract,  thus  diminishing  the  afflux  of  blood 
to  the  affected  tissue.  The  persistent  application  of  cold,  how- 
ever, may  cause  gangrene  ;  but  the  employment  of  the  ether  or 
rhigolene  spray  is  attended  with  less  danger  in  this  respect 
than  that  of  ice  applications.  A  granulating  surface,  on  the 
other  hand,  develops  better  in  a  warm  temperature. 

Heat  and  Moisture. — Heat  is  also,  under  certain  circum- 
stances, a  valuable  antiphlogistic.  Dry  heat  will  mitigate  pain, 
and  heat  with  moisture  in  the  form  of  a  poultice,  is  very  com- 
monly used  to  relieve  the  pain  and  tensive  heat  of  local  in- 
flammation by  its  soothing  and  relaxing  effect.  While  cold 
has  an  astringent,  sedative  effect,  and  constringes  the  capilla- 
ries of  the  inflamed  tissue,  thus  promoting  healing  by  resolu- 
tion, moist  heat  is  relaxing  and  promotes  exudation,  if  not 
suppuration,  leading  to  repair  by  "  the  second  intention."  The 
use  of  cold  is  dispensed  with  in  inflammatory  conditions  as 
soon  as  it  is  apparent  that  the  termination  of  the  inflammation 
by  resolution  is  impossible,  when  resort  is  had  to  poultices  or 
warm  fomentations,  such  as  flax-seed  and  slippery-elm  bark, 
to  which  vaseline,  boracic  acid,  or  a  weak  solution  of  car- 
bolic acid  may  be  added,  to  prevent  fermentation  in  the 
poultice,  and  putrefaction  in  the  wound.  To  relieve  pain, 
tincture  of  opium  maybe  applied  to  the  surface  of  the  poultice, 
a  water-dressing  composed  of  cloth  saturated  with  warm 
water,  or  a  medicated  solution,  such  as  boracic  acid  or  biborate 
of  sodium.  The  local  warm  bath  is  also  another  method  of 
applying  heat  and  moisture,  as  the  granulations  of  a  surface 
immersed  in  tepid  water  develop  favorably;  and  an  ulcerated 
surface  which  has  been  subjected  to  a  prolonged  warm  bath, 
made  antiseptic  by  carbolic  acid,  or  the  application  of  an  eight 
per  cent,  solution  of  chloride  of  zinc,  is  greatly  benefited. 
Warmth  and  moisture  are  especially  indicated  for  parts  having 
a  feeble  circulation.  Warm,  moist  applications,  such  as  poul- 
tices, promote  the  tendency  to  suppuration;  hence,  care  should 


40  DENTAL  MEDICINE. 


be  observed  in  applying  such  applications  to  the  surface  of  the 
face,  in  the  case  of  an  alveolar  abscess,  as  pointing  and  the 
escape  of  pus  may  be  induced  in  a  position  where  permanent 
disfigurement  would  be  very  apparent. 

Compression  is  also  of  service  in  the  treatment  of  certain 
forms  of  inflammation,  especially  during  the  late  stages  ;  but 
it  must  be  uniformly,  moderately^  and  continuously  applied. 
Even  in  the  acute  form,  compression  may  prevent  the  over-dis- 
tention  of  the  capillaries  and  limit  the  exudation  ;  in  the  chronic 
form,  compression  promotes  absorption.  It  is  accomplished 
by  means  of  bandages,  either  alone  or  in  conjunction  with  cot- 
ton batting,  as  the  latter  prevents  irregular  constriction  and 
maintains  a  uniform  temperature.  A  fine  compressed  sponge, 
moistened,  after  it  is  applied,  with  tepid  water,  is  a  painless 
and  effective  means  for  obtaining  compression  in  the  treatment 
of  indolent  ulcers.  Compression  by  means  of  sheet  lead  or 
tin,  and  pads  of  bibulous  paper,  will  often  prevent  an  alveolar 
abscess  from  discharging  on  the  surface  of  the  cheek  or  neck, 
when  such  an  event  is  imminent. 

Blood-letting. — General  blood-letting  is  now  rarely  employed 
in  the  treatment  of  inflammation ;  but  the  local  abstraction  of 
blood  by  means  of  leeches,  cups,  scarification,  incisions,  and 
other  means,  is  of  great  service  in  reducing  vascular  action, 
and  lessening  inflammatory  symptoms.  The  efficiency  of  local 
depletion  in  relieving  hyperaemia  is  very  evident  by  the  cessa- 
tion of  pain  caused- by  strangulation  and  tension.  Periodon- 
titis and  acute  gingivitis  furnish  examples.  Leeches  should 
never  be  applied  to  a  part  where  it  would  be  difficult  to 
arrest  the  hemorrhage  which  may  follow  their  use;  their 
application  is  also  contra-indicated  in  the  case  of  children,  who 
cannot  bear  the  loss  of  considerable  blood  with  impunity. 

Incisions  are  made  for  the  purpose  of  relieving  tension  and 
pain,  evacuating  pus,  or  the  escape  of  dead  material,  for 
tension  aggravates  the  inflammation  and  the  retention  of 
pus  in  an  abscess,  prolongs  the  pain,  and  also  adds  to  the 
destruction  of  parts  by  the  formation  of  gangrenous  patches. 
Superficial  incisions  will   relieve  the  tension  of  the   skin  and 


INFLAMMATION.  41 


mucous  membrane,  and  also  evacuate  the  pus  of  an  abscess 
when  it  is  near  the  surface. 

Deeper  incisions  are  necessary  when  the  pus  is  at  a  greater 
distance  from  the  surface,  and  there  is  considerable  tension. 
Incisions  are  also  often  judicious  as  a  prevention  of  suppura- 
tion and  ulceration  ;  also  in  cases  where  the  presence  of  pus 
is  suspected,  but  there  is  no  apparent  fluctuation.  In  making 
deep  incisions,  care  is  necessary  to  avoid  wounding  arteries 
and  nerves ;  hence  the  director  should  precede  the  use  of  the 
knife.  In  acute  abscesses  the  incisions  should  be  made  at  an 
early  stage,  and  of  such  a  size  as  will  permit  of  the  free  evacu- 
ation of  the  pus,  and  in  the  most  depending  position,  to  insure 
its  easy  discharge.  Hence,  as  soon  as  fluctuation  is  detected 
in  an  acute  abscess,  the  incision  for  the  escape  of  the  pus 
should  be  made ;  while  in  the  case  of  a  chronic  or  cold 
abscess,  the  incision  may  be  delayed,  or  a  puncture  with  a 
trocar  substituted  for  it,  which  may  at  once  be  closed. 

Drainage  is  employed  for  the  purpose  of  giving  outlet  for 
any  matters  liable  to  collect  in  a  wound  or  abscess  which  may 
act  as  obstacles  to  the  process  of  repair.  Teeth  affected 
with  abscess  are  often  relieved  and  retained  by  an  opening 
made  into  the  pulp  canal  or  into  the  abscess  sac,  sufficiently 
free  to  relieve  the  tension  and  drain  off  the  accumulated  pus  ; 
also  in  the  case  of  abscess  of  the  antrum,  where  an  opening 
made  through  the  alveolar  cavity  of  one  of  the  roots  of  a 
posterior  tooth  is  kept  open  by  means  of  a  canula,  to  relieve 
the  tension  and  permit  the  pus  to  escape  as  it  accumulates, 
and  also  to  afford  an  easy  entrance  for  the  injection  of  anti- 
septic and  stimulating  agents  in  the  treatment  of  such  cases. 
Drainage  can  also  be  made  through  soft  tissues,  such  as  the 
gum,  etc.,  by  strands  of  floss  silk,  hemp  thread,  and  horse 
hair,  dipped  in  a  carbolic  acid  solution  before  they  are  inserted 
into  the  opening  connected  with  the  sac  ;  also  by  means  of 
caoutchouc  tubing. 

Counter  Irritatio7i,  "  counter  irritants,"  or  "  derivatives,"  are 
also  employed  in  the  treatment  of  inflammation,  for  the  pur- 
pose of  inducing  an  afflux  of  blood   from  the   locality  of  the 


42  DENTAL  MEDICINE. 


inflammation  to  another  point  in  close  proximity,  thus  reliev- 
ing the  vessels  of  the  affected  part.  Such  counter-excitement 
in  the  case  of  the  oral  mucous  membrane,  is  induced  by- 
blistering  applications,  stimulants,  escharotics,  etc.,  which 
excite  a  new  action  in  a  part  more  or  less  remote  from  the 
focus  of  inflammation. 

Cantharidal  collodion,  tincture  of  iodine,  either  alone  or  in 
combination  with  aconite,  or  with  creasote,  or  with  carbolic 
acid,  nitrate  of  silver,  nitric  acid,  and  the  actual  cautery,  may 
be  named  as  the  most  common  counter-irritants  for  applica- 
tion to  the  oral  mucous  membrane  in  the  case  of  deep-seated 
inflammation  and  pulpitis,  and  are  mainly  useful  in  the  early 
stage  of  the  acute  form,  and  in  the  chronic  form. 

Mouth  Washes  and  Lotions,  such  as  tincture  of  myrrh, 
chlorate  of  potassa,  solutions  of  carbolic  acid,  listerine,  per- 
manganate of  potash,  nitrate  of  silver,  sulphate  of  copper, 
sulphate  of  zinc,  oxide  of  zinc,  lead  water,  tincture  of  opium, 
a  weak  solution  of  pyrozone,  etc.,  are  employed  with  benefit 
in  superficial  inflammations  and  ulcerations  of  the  oral  mu- 
cous membrane. 

When  putrefaction  is  present  in  the  inflamed  part,  chlorinous 
washes  are  serviceable  for  deodorizing  purposes,  and  also  to 
prevent  the  entrance  of  putrid  matter  into  the  circulation. 
The  object  of  cauterizing  an  inflamed  part  is  to  break  the  con- 
tinuity of  the  morbid  process. 

AncBsthetics,  such  as  chloroform,  ether,  etc.,  when  employed 
in  the  treatment  of  inflammation,  exercise  an  influence  as 
preventives,  and  also  render  lax  tissues  which  become  very 
rigid,  and  enable  reductions  to  be  made,  as  well  as  temporarily 
mitigating  the  pain ;  fracture  and  dislocation  of  the  jaw  are 
examples. 

When  inflammation  has  devitalized  parts,  the  treatment 
varies  in  respect  to  the  nature  of  such  parts.  Dead,  soft  tissues 
are  to  be  so  treated  that  the  putrid  matter  is  prevented  from 
entering  the  circulation,  by  the  application  of  antiseptic  agents, 
which  have  in  a  great  measure  replaced  antiphlogistics ;  hence, 
antiseptics    which   possess  the    power    of  destroying    micro- 


INFLAMMATION.  43 


organisms  without  the  danger  of  destroying  the  vitality  of 
the  tissues,  are  considered  to  be  the  most  active  agents  of 
this  class.  When  the  hard  tissues  are  devitalized,  such  as 
bone,  for  example,  although  the  living  bone  becomes  separate 
from  the  dead  portion  as  effectually  as  a  living  soft  part  from 
its  slough,  yet,  it  is  necessary  to  liberate  the  bony  sequestrum 
from  the  overlying  texture  which  may  confine  it ;  hence  the 
removal  of  dead  bone  is  necessary  as  soon  as  the  line  of  de- 
marcation is  formed,  the  time  for  which  may  vary  from  a 
period  of  less  than  three  weeks  in  the  case  of  small  sequestra, 
to  more  than  two  months,  where  the  entire  bone  is  involved. 
Also  in  cases  where  the  extremity  of  a  part  consisting  of  soft 
and  hard  tissues,  for  example,  the  alveolar  process  and  tissues 
over  it,  become  gangrenous,  it  is  best,  in  most  instances,  to 
remove  the  dead  tissues  by  amputation  ;  and  such  an  operation 
may  also  become  necessary  in  cases  of  long-continued  ex- 
haustive suppuration.  Many  forms  of  inflammation  have 
their  special  remedies,  such  as  mercurial  inflammation  of  the 
mouth,  when  chlorate  of  potash  is  indicated  ;  periodontitis, 
when  tincture  of  iodine  and  tincture  of  aconite,  or  creasote,  or 
carbolic  acid,  in  combination  with  the  iodine,  etc.,  are  indicated  ; 
gingivitis,  where  stimulating  and  antiseptic  washes  and 
lotions  of  tincture  of  myrrh,  biborate  of  soda,  carbolic  acid 
solutions  and  combinations,  etc.,  are  indicated. 

The  diet  is  of  great  importance  in  all  forms  of  inflammation. 
Food  of  the  most  nutritious  character  and  of  a  form  easily 
digested  is  very  necessary.  Milk,  pure,  or  mixed  with  lime 
water,  peptonized  or  sterilized,  or  in  the  form  of  gruel,  is  the 
most  valuable  of  all  liquid  foods ;  alcohol  may  be  given  with 
it  in  the  form  of  wine  whey.  Meat  broths  are  nutritious  and 
digestible,  and  pure  beef  juice  is  very  reliable.  When  food 
cannot  be  taken  by  the  stomach,  enemata  of  beef  broths,  and 
some  of  the  various  peptonized  forms  of  meat,  may  be  given 
by  the  rectum.  A  few  drops  of  laudanum  with  the  enema 
will  assist  in  retaining  food  thus  given.  After  the  fever  and 
inflammation  subside,  the  solid  forms  of  food  may  be  given 
more    freely.      Tonics,  such  as   iron,  calisaya   bark  and   the 


44  DENTAL  MEDICINE. 


phosphites,  are  then  indicated  to   improve   the  appetite  and 
favor  repair. 

General  Remarks. — In  every  case,  the  first  object  should  be 
to  ascertain  and,  if  possible,  remove  the  cause  of  a  disease. 
It  should  be  remembered  that  medicinal  substances  are  always 
more  certain  in  their  action  when  applied  directly  to  the 
affected  tissue ;  also,  that  chemical,  physical  and  vital  changes 
result  from  the  topical  action  of  such  substances ;  and  that  age 
modifies  the  effects,  and  also  determines  the  dose ;  also  sex, 
owing  to  the  greater  susceptibility  of  the  nervous  system  in 
females  than  in  males  ;  also  the  temperament,  as  the  sanguine, 
for  example,  is  more  susceptible  to  the  influence  of  medicinal 
agents  than  the  phlegmatic;  also  habit  and  mode  of  life,  as  the 
habitual  use  of  such  agents  as  stimulants  lessens  their  influ- 
ence, and  the  occupation  affects  the  susceptibility  to  external 
influence;  also //^^  condition  of  the  body,  d.s  different  diseases 
exercise  considerable  influence  on  the  effects  of  medicinal 
substances  ;  also  the  mind,  as  a  hopeful  mind  conduces  to  the 
beneficial  action  of  medicines ;  also  idiosyncrasy,  as  some  indi- 
viduals are  more  susceptible  to  the  action  or  effects  of  medi- 
cinal substances  than  others  ;  also  the  nature  of  the  tissue  or 
organ  to  which  application  is  made,  as  some  are  more  suscep- 
tible to  the  effect  of  medicinal  agents  than  others,  owing  to 
rapidity  of  absorption  and  the  degree  of  decomposition  of  the 
substance  employed ;  also  climate,  from  the  recognized  influ- 
ence of  climate  in  modifying  the  structure  and  functions  of 
the  animal  economy,  and  increasing  or  diminishing  morbid 
conditions,  and  by  such  means  influencing  the  effects  of  medi- 
cinal agents. 

In  most  acute  diseases  there  is  a  tendency  to  recovery  after 
a  certain  time  has  elapsed,  in  case  there  is  no  failure  in  the 
functions  of  any  of  the  essential  organs ;  hence,  in  all  acute 
diseases,  the  state  of  the  nervous  system  should  be  carefully 
watched. 

When  the  affection  is  not  of  a  serious  character,  such  symp- 
toms as  are  especially  troublesome  may  be  relieved  ;  but  when 
the   nervous  and  vascular   systems   are   affected,  both  locally 


INFLAMMATION.  45 


and  generally,  then  it  is  necessary  that  the  proper  measures 
for  their  relief  be  promptly  taken. 

Where  mucous  membrane  is  the  seat  of  the  affection,  it  is 
often  possible  to  remove  the  exciting  cause.  There  are  also 
many  inflammatory  affections  met  with,  where,  from  the  begin- 
ning, there  is  a  diminished  action  of  the  heart,  and  a  depressed 
state  of  the  nervous  centres.  In  the  treatment  of  such  cases, 
the  depressed  condition  of  the  general  system  chiefly  requires 
attention,  as  the  progress  and  termination  of  the  local  affection 
depend  upon  the  cause   from  which    it  has  originated. 

There  are  also  morbid  states  not  necessarily  dependent  on 
organic  disease.  Various  acids  are  produced  by  the  fermenta- 
tion of  substances  containing  starch  or  sugar,  and  there  is 
reason  for  believing  that  an  increased  secretion  of  acid  may 
take  place  from  the  mucous  membrane  of  the  stomach  and 
produce  symptoms  of  acidity  independently  of  fermentation, 
although  one  of  the  properties  of  the  gastric  fluid  is  to  prevent 
fermentation.  The  symptoms  of  acidity  are  a  sour  taste,  and 
the  occurrence  of  acid  eructations,  often  accompanied  with 
heartburn,  and  sometimes  with  diarrhoea,  and  a  feeling  of 
sinking  at  the  epigastrium. 

In  these  cases  the  cause  must  be  sought  for,  and  such  treat- 
ment instituted  as  will  neutralize  the  acidity  and  stimulate  the 
peptic  glands  to  an  increased  secretion  of  the  digestive  fluid ; 
also  such  as  will  regulate  the  bowels.  Due  attention  must 
also  be  given  to  the  diet,  which  should  consist  of  such  sub- 
stances as  will  not  readily  ferment,  and  all  food  containing 
starch  should  be  avoided. 

Although  topical  remedies  are  more  generally  employed  in 
the  treatment  of  dental  affections,  yet  there  are  many  diseases 
of  the  oral  cavity  which  are  due  to  remote  causes  and  require 
constitutional  as  well  as  local  treatment. 

The  appearances  presented  by  the  mucous  membrane  of  the 
mouth  are  valuable,  as  indicating  the  state  of  other  parts  more 
remote ;  and  it  is  frequently  the  case  that,  when  the  constitu- 
tional affection  is  overcome,  the  local  symptoms  disappear  as 
a  consequence,  or  become  very  amenable  to  local  remedies. 


46  DENTAL  MEDICINE. 


IMPORTANT  POINTS  IN  DIAGNOSING  AFFECTIONS  OF  THE 
MOUTH,  WITH  A  SYNOPSIS  OF  TREATMENT. 

The  Irritation  of  Teetliing  is  indicated  by  a  hot,  swollen  and 
tender  condition  of  the  gums,  fretfulness,  irritable  temper, 
refusal  of  nourishment,  fever  and  thirst,  and,  if  not  relieved, 
diarrhoea  with  offensive  motions,  sometimes  a  troublesome 
cough,  convulsions,  and  other  serious  results. 

An  Abnormal  Dentition  is  indicated  by  a  hot,  dry  mouth, 
swollen  gums,  tense,  tender  and  shining,  fever,  disordered 
bowels,  fretfulness,  eruption  of  skin,  diarrhoea,  convulsions. 

Cojivulsions  of  Dentition  are  indicated  by  such  premonitory 
symptoms  as  irritable  temper,  unusual  brightness  of  eyes, 
indisposition  to  eat  or  sleep,  slight  involuntary  movements  of 
muscles  of  face  or  extremities,  grinding  of  teeth.  The  par- 
oxysm is  indicated  by  rigidity  of  body,  utterance  of  a  cry, 
face  turning  red  or  purple,  veins  of  neck  turgid,  suspension  of 
respiration,  loss  of  consciousness,  irregular  and  intermittent 
contractions  of  muscles,  protrusion  of  tongue,  frothing  at  lips, 
distortion  of  face,  rolling  of  eyeballs,  contracted  and  rapid 
pulse. 

Treatment. — For  the  relief  of  the  premonitory  symptoms  of 
dentition,  bromide  of  potassium  in  doses  of  gr.  iij  to  v,  accord- 
ing to  age,  every  ten  minutes.  Demulcent  and  soothing 
lotions  to  the  gums.  An  aperient  if  no  diarrhoea  is  present. 
For  more  decided  symptoms,  scarification  or  lancing  of  the 
gums.  An  enema  of  soap  and  water  to  relieve  the  digestive 
canal  of  irritating  substances,  or  the  use  of  the  following  com- 
bination to  abate  the  fever  and  allay  the  irritability  of  stomach 
and  bowels  '.— 

R .    Potass,  bromidi  pulv gr.  xv 

Potass,  nit.  pulv , gr.  ^^ij 

Zinci  oxidi .  gr.  ij  M. 

Divide  in  chart.  No.  VI. 

SiG. — One  powder  every  four  hours,  until  bed-time. 

For  the  diarrhoea  :  change  the  diet,  adopt  hygienic  measures  ; 
mild  purgatives  in  small  doses.     For  acid  dejections,  calcined 


DIAGNOSIS  OF  MOUTH  AFFECTIONS.  47 


magnesia;  or  small  doses  of  sulphate  of  magnesia  and  tincture 
of  rhubarb  ;  or  of  pulv.  ipecac.,  pulv.  rhubarb  and  bicarbonate 
of  soda;  or  castor  oil  in  doses  of  5ss.  For  infancy  diarrhoeas 
Dr.  Thomas  claims  excellent  results  from  the  following  mix- 
tures in  gastric  or  gastro-intestinal  dyspepsia,  characterized 
by  nausea,  vomiting,  flatulence  and  diarrhoea  with  non-slimy, 
fetid,  yellowish  or  greenish  stools.  ^.  Lactic  acid,  3j  ;  sim- 
ple syrup,  5v ;  water,  oiijss.  M.  Sig. — One  drachm  every 
quarter  to  half  hour  after  meals.  (See  Dr.  James  W.  White's 
recipes  under  opium,  chloroform,  aromatic  sulphuric  acid  and 
bromide  of  potassium.) 

For  convulsions  :  the  administration  of  an  anaesthetic  to 
abort  or  control  the  spasmodic  movements ;  hydrate  of  chloral, 
gr.  V  to  X,  according  to  age,  dissolved  in  two  or  three  drachms 
of  water,  and  injected  into  the  rectum  ;  or  the  administration 
of  bromide  of  potassium ;  use  of  hot  foot  bath,  to  which  is 
added  a  small  quantity  of  mustard ;  the  warm  bath ;  and 
when  cerebral  congestion  is  threatened,  cold  applications  to 
the  head. 

According  to  Dr.  A.  Brothers  :  i.  Dentition  is  rarely,  if 
ever,  a  direct  cause  of  death. 

2.  Precocious  or  retarded  dentition  may  occur  in  otherwise 
healthy  children  or  in  entire  families. 

3.  The  period  of  eruption  of  the  first  teeth  occurs,  in 
healthy,  breast-fed  children,  at  six  and  a  half  months  in  the 
vast  majority  of  cases,  and  first  dentition  is  usually  complete 
at  thirty  months. 

4.  Dentition  is  distinctly  retarded  in  the  first  as  well  as  the 
later  teeth  in  children  brought  up  on  a  mixed  or  artificial  diet. 

5.  Congenital  diseases — tuberculosis,  syphilis,  endocarditis 
— seem  to  have  a  retarding  influence  on  dentition. 

6.  Rachitis  has  a  very  pronounced  retarding  influence  on 
the  whole  course  of  dentition. 

7.  Scrofulosis  seems  to  hasten  the  eruption  of  the  first  teeth, 
but  does  not  affect  the  later  teeth. 

8.  In  cases  of  undeveloped  brain — idiocy — there  is  a  marked 
retardation  during  the  entire  period  of  dentition. 


48  DENTAL  MEDICINE. 


9.  Chronic  diseases  have  a  retarding  power  over  the  first 
teeth,  but  do  not  seem  to  influence  the  later  teeth. 

10.  Children  suffering  fi'om  marasmus  seem  to  be  precocious 
with  the  first  teeth,  but  delayed  with  the  later  teeth. 

11.  Cases  of  epilepsy,  developing  in  early  infancy,  seem  to 
have  their  first  teeth  appear  early. 

Hemorrhage  after  Extraction. — Remove  loose  clot,  wash  out 
cavitywith  hot  water;  then  plug  cavity  with  iodoform  gauze  ; 
or,  cotton  dipped  in  mastic,  and  rolled  in  tannin  ;  or,  cotton 
saturated  with  oil  of  turpentine,  or  perchloride  of  iron ;  or, 
ferric  alum  ;  or,  cotton  saturated  with  phenol  sodique,  and 
then  dipped  in  tannic  acid  ;  or,  antipyrine  on  cotton.  In- 
ternally :  Administer  three  grains  of  tannic  acid  dissolved  in 
two-thirds  of  a  tumbler  of  water,  of  which  two  teaspoonsful 
are  given  every  five  minutes  until  three  doses  have  been  taken, 
after  which  give  the  same  quantity  every  fifteen  minutes.  Gallic 
acid,  ergot,  or  oil  of  turpentine,  may  also  be  given  internally, 
especially  when  the  hemorrhage  is  indicative  of  some  consti- 
tutional vice.  In  addition,  upright  posture,  and  a  cool  apart- 
ment. 

For  After-pains  of  Tooth  E'Ktraction. — A  single  drop  of  nitro- 
glycerine, one  per  cent,  solution,  in  half  a  glass  of  cold  water. 
The  careful  inhalation  of  one  or  two  drops  of  amyl-nitrite  for 
three  or  four  seconds,  followed  by  complete  rest  for  five  min- 
utes, is  also  recommended.  Also,  locally,  Fletcher's  carbolized 
resin,  composed  of  resin,  carbolic  acid,  and  chloroform,  which 
is  a  good  styptic  also ;  or,  chloroform  one  part,  and  tincture 
of  pyrethrum  three  parts. 

Pericementitis,  or  Periodontitis  or  Inflammation  of  the  Peri- 
dental Membrane  is  indicated  by  a  sense  of  uneasiness  and  full- 
ness, which  is  at  first  relieved  by  pressure,  but,  after  active 
inflammation  is  established,  pressure  on  the  affected  tooth 
causes  intense  pain,  of  a  dull,  heavy,  annoying  character.  The 
tooth  is  also  protruded,  to  a  slight  degree,  from  the  alveolus, 
and  also  somewhat  loosened,  owing  to  the  thickening  of  the 
investing  membrane  ;  and  the  inflammation,  which  is  at  first 
manifested  by  a  red  line  near  the  margin  of  the  gum,  becomes 


DIAGNOSIS  OF  MOUTH  AFFECTIONS.  49 


general  over  the  entire  root,  sometimes  involving  the  neigh- 
boring gum,  and  even  the  palate  and  cheek,  and  symptoms  of 
febrile  disturbance.  If  not  arrested,  a  suppurative  condition, 
alveolar  abscess,  ensues.  A  modification  of  the  symptoms 
just  enumerated,  the  tooth  being  tender  to  pressure,  more  or 
less  raised  in  its  cavity,  and  surrounded  by  a  reddened  and 
swollen  gum,  with  a  varying  amount  of  pain,  and  the  discharge 
of  pus  from  around  the  neck,  or  from  a  fistulous  opening  in 
the  gum,  and  such  symptoms  continuing  for  a  long  time,  in- 
dicate the  chronic  form  of  an  adv^anced  state  of  periodontitis, 
which  often  results  from  systemic  influences. 

Treatment. — Remove  all  irritants ;  apply  counter-irritants, 
such  as  equal  parts  of  tinct.  iodine  and  tinct.  aconite ;  or  can- 
tharidal  collodion  ;  or  iodine  and  creasote,  or  carbolic  acid  ;  or 
capsicum  in  form  of  tincture,  or  in  small  bags  of  the  powder 
to  surface  of  gum  over  root  of  affected  tooth.  Depletion  by 
the  lancet,  leeches  or  cups.  Hypodermic  injection  of  mor- 
phine, or  tinct.  of  opium.  Application  of  spray  of  rhigolene 
or  absolute  ether  until  gum  is  blanched.  To  relieve  pain,  a 
solution  of  equal  parts  of  tinct.  aconite,  tinct.  of  opium,  and 
chloroform  ;  or  lead  water  and  tinct.  opium.  Disinfecting  the 
root-canals,  after  the  removal  of  a  decomposed  or  dead  pulp, 
by  means  of  disinfectant  and  antiseptics,  viz. :  peroxide  of 
hydrogen,  or  pyrozone,  in  three,  five,  or  twenty-five  per  cent, 
solutions  used  alternately.  Constitutional  treatment :  Saline 
cathartics;  bromide  of  potassium,  gr.  xxv,  combined  with  gtt. 
V  of  tinct.  veratrum,  every  four  hours;  or  bromide  of  potas- 
sium alone,  in  doses  of  gr.  xxv  or  xxx;  or  hot  water  applica- 
tions to  face  and  neck,  and  calcium  sulphide  in  tV  gr.  pill  until 
eight  have  been  taken  in  two  hours,  then  one  every  half-hour 
for  two  hours;  or,  drachm  doses  of  fluid  extract  of  gelsemium, 
minims  x.,  water  Sj,  every  fifteen  minutes  until  four  doses  have 
been  taken,  then  every  half-hour  for  two  hours.  The  tooth 
protected  from  irritation  during  treatment,  by  a  cap  over  ad- 
joining teeth.  The  removal  of  the  extremity  of  the  root  of  a 
tooth  affected  with  chronic  periodontitis,  by  means  of  a  trepan, 
has  also  been  suggested. 
4 


50  DENTAL  MEDICINE. 


Alveolar  Abscess  is  first  indicated  by  pain  of  a  constant  char- 
acter, which  is  afterward  aggravated  at  each  pulsation  ;  then 
sweUing  about  the  roots  of  the  affected  tooth,  which  at  length 
becomes  defined  and  prominent,  and  afterward  points  and  dis- 
charges pus,  when  the  active  symptoms  subside.  The  devel- 
opment of  alveolar  abscess  is  indicated  by  such  constitutional 
symptoms  as  foul  tongue,  offensive  breath,  hot  skin,  thirst  and 
headache,  and  when  the  suppuration  is  considerable,  symp- 
tomatic fever  and  rigors. 

The  characteristic  pain  of  an  alveolar  abscess  is  deep-seated 
and  throbbing,  and,  with  the  swelling,  denotes  the  formation 
of  pus.  A  chronic  form  ef  alveolar  abscess  is  indicated  by  a 
subsidence  of  the  active  symptoms,  and  a  continuance  of  the 
discharge  of  small  quantities  of  pus  through  a  fistulous  open- 
ing opposite  the  root  of  the  affected  tooth,  or  about  its  neck. 
An  elastic  fluctuating  swelling  in  any  part  of  the  face,  or  for 
some  distance  down  the  neck,  may  result  from  abscessed 
teeth. 

Treatment. — Remove  all  irritants.  Give  free  vent  for  the 
escape  of  the  pus.  Destroy  sac  of  abscess  by  therapeutic 
treatment,  or  by  a  surgical  operation.  Therapeutic  treatment : 
First  cleanse  the  root-canal  by  injections  of  chloride  of  sodium 
or  peroxide  of  hydrogen,  or  pyrozone,  or  peroxide  of  sodium ; 
escharotics  to  destroy  the  sac,  such  as  creasote,  carbolic  acid, 
salicylic  acid,  nitrate  of  silver,  iodine,  dilute  aromatic  sulphuric 
acid,  to  which,  in  chronic  cases,  add  tinct.  of  capsicum ;  also 
antiseptics  :  bichloride  of  mercury,  chloroform  and  aristol,  also 
oil  of  cassia  and  oil  of  gaultheria,  in  combination  with  carbolic 
acid,  kalium-natrium,  etc.,  etc.  The  surgical  method  consists 
in  gaining  access  to  the  sac,  by  means  of  a  bistoury  or  small 
trephine,  through  the  fistulous  opening,  where  such  exists,  and 
detaching  and  breaking  up  the  sac  by  means  of  suitable  nerve 
instruments  and  the  application  of  escharotic  agents.  Dr. 
Brophy,  speaking  of  cases  of  alveolar  abscess  where  the  disease 
is  in  the  bone,  says  :  "  In  such  cases  if  the  treatment  is  simply 
opening  into  the  tooth  for  drainage  with  the  expectation  that 
nature  will  effect  a  cure,  we  will  be  disappointed.    In  such  cases 


DIAGNOSIS  OF  MOUTH  AFFECTIONS.  51 


an  incision  should  be  made  down  to  the  diseased  bone,  pack- 
ing it  with  iodoform  gauze,  or  boracic  acid  gauze.  The  next 
day  with  a  bur  cut  off  the  affected  portion  of  the  roots  of  the 
teeth  because  they  are  a  source  of  irritation  ;  then  with  a  bud- 
bur  pass  over  the  bone,  and  remove  the  dead  portions,  and 
again  pack  the  wound  with  antiseptic  gauze.  In  a  day  or  two 
make  an  examination,  and  if  heahhy  granulations  are  begin- 
ning, insert  a  wax  plug,  which  is  not  permeable  like  the  gauze, 
-to  prevent  the  wound  from  closing,  and  the  consequent  trouble 
from  confined  pus." 

Alveolar  Abscess  about  to  point  Externally  is  indicated  by  the 
skin,  for  some  distance  around  the  central  point,  becoming  red 
and  distended,  with  a  throbbing  sensation,  succeeded  by  a 
change  in  the  appearance  of  the  skin  to  a  thin  and  scaly  sur- 
face, from  which  the  epidermis  scales  off.  The  integument 
becomes  glued  down  to  the  bone  around  the  spot  where  the 
pus  will  ultimately  appear  ;  the  latter  following  a  fistulous 
track  between  the  diseased  tooth  and  the  surface  of  the  cheek, 
the  fistula  remaining  open  and  discharging  as  long  as  the  in- 
flammatory action  continues. 

Treatment. — Make  a  free  incision  in  the  gum  opposite  and 
near  the  apex  of  the  root  of  the  affected  tooth.  Apply  to  the 
surface  of  the  threatened  point  of  exit  of  the  pus,  alcohol,  or 
spirits  of  camphor,  or  paint  with  collodion,  and  make  gentle 
pressure  by  means  of  a  compress  of  sheet  lead  or  sheet  tin,  or 
pads  and  bandage,  to  change  the  direction  of  the  pus. 

Abscess  of  the  Aiitnun  is  indicated  by  a  discharge  of  pus  into 
the  nose,  sometimes  producing  scarcely  any  discomfort ;  at 
other  times  the  severest  local  and  constitutional  suffering  ;  an 
aching  pain  in  the  cheek,  which  is  hot,  flushed,  and  somewhat 
swollen  ;  and,  as  the  symptoms  increase,  greater  pain,  of  a 
throbbing  character,  with  the  rigors  and  fever  peculiar  to 
suppuration  ;  an  expansion  of  the  bone  of  the  upper  jaw  ;  an 
elevation  of  the  malar  bone,  with  a  very  apparent  depression 
beneath  it ;  the  molar  teeth  on  the  affected  side  depressed  so 
as  to  appear  elongated,  and  to  prevent  the  proper  closure  of 
the  mouth;  an  increase  of  pus  ;  the  palate  losing  its  concavity 


52  DE]\iTAL  MEDICINE. 


and  becoming  convex ;  the  nostril  of  the  affected  side  being 
encroached  upon,  and,  in  protracted  cases,  the  floor  of  the 
orbit  of  the  eye  so  pushed  upas  to  force  the  eye  partly  from  its 
socket ;  the  sight  affected  by  the  stretching  of  the  optic  nerve  ; 
the  walls  of  the  antrum  becoming  so  thin  as  to  afford  evidence 
of  fluid-fluctuation  on  pressure;  at  length  the  pus  escaping 
through  the  cheek,  or  into  the  nose,  or  burrowing  along  the 
side  of  a  root  of  a  tooth  and  discharging  into  the  mouth ;  the 
floor  of  the  orbit  giving  way  and  the  pus  discharging  along 
the  lower  eyelid. 

Treatment. — Make  an  opening  into  the  antrum,  either 
through  the  alveolar  cavity  of  one  of  the  roots  of  a  superior 
first  or  second  molar,  or  through  the  process  between  the  roots 
of  the  second  and  third  molars,  which  is  the  most  dependent 
portion  of  the  antral  cavity,  with  a  suitable  trephine,  and 
thoroughly  wash  out.  the  cavity  with  a  warm  injection  of  salt 
5j  to  water  Oss,  and  if  there  is  an  offensive  odor,  syringe  with 
a  solution  of  permanganate  of  potash  ;  then  dress  daily  with  a 
solution  composed  of  carbolic  acid  one  part,  and  oil  of  sweet 
almonds  fifteen  parts,  applied  on  cotton  secured  in  the  cavity. 
If  no  improvement,  then  syringe  the  antrum  with  a  solution 
consisting  of  carbolic  acid  5j,  tinct.  iodine  oj,  water  oviij. 
Where  a  more  powerful  stimulant  is  required,  use  an  injection 
of  zinc,  gr.  x  to  the  ounce  of  water.  For  systemic  treatment, 
administer  sulplifde  of  calcium  in  the  form  of  one-tenth  of  a 
grain  pill  three  times  a  day,  after  meals,  doubling  the  dose  if 
necessary.  [Dr.  Frank  Abbott)  Dr.  J.  S.  Marshall  recom- 
mends as  a  wash  for  the  antrum,  boracic  acid  twelve  parts, 
salicylic  acid  four  parts,  water  one-thousand  parts ;  iodoform, 
iodol,  aristol,  pyoktanin,  sulphonal  and  boric  acid,  in  form  of 
powder,  are  also  recommended.  M.  Emile  Denis  recommends 
syringing  out  the  cavity  twice  a  day  with  a  sixteen  per  cent, 
solution  of  boricine  (see  boricine),  and  then  applying  about  a 
teaspoonful  of  the  powered  boricine. 

Alveolar  Ulceration  is  distinguished  from  alveolar  abscess 
by  the  presence  of  an  ulcerated  surface  of  peridental  membrane 
instead  of  pus  contained  in  a  fibrous  sac,  the  purulent  matter  in 


DIAGNOSIS   OF   MOUTH   AFFECTIOXS.  53 

alveolar  ulceration  oozing  out  through  the  gum  or  around  the 
neck  of  the  affected  tooth  :  no  new  tissue  is  formed,  as  in  the 
case  of  abscess ;  but  the  normal  tissue  is  disorganized  and 
wasted,  and  the  matter  discharged  is  watery,  translucent,  and 
may  be  in  some  cases  odorless,  while  that  from  an  abscess  is 
thick,  opaque  and  offensive.  Ulceration  causes  little  or  no 
swelling,  and  the  inflammation  is  phagedenic  in  character, 
destroying  hard  and  soft  tissues  by  chemical  decomposition. 
Like  alveolar  abscess,  it  may  be  due  to  the  death  of  the  pulp, 
and  it  may  begin  as  abscess,  not  being  a  primar5^  disease,  but 
always  preceded  by  some  other  well-established  and  usually 
chronic  affection.  In  alveolar  ulceration  a  considerable  por- 
tion of  the  peridental  membrane  is  destroyed,  and  there  is  a 
wasting  away  of  the  alveolus  and  cementum  in  the  region  of 
the  ulcer,  whereas  in  alveolar  abscess  the  peridental  membrane 
may  remain  in  an  inflamed  and  morbid  condition  and  the  alveo- 
lar walls  firm  and  penetrated  at  one  point  to  permit  of  the 
escape  of  the  pus.  In  long-continued  alveolar  ulceration,  as 
a  result  of  the  disease,  calcareous  deposits,  in  the  form  of 
granules,  collect  on  the  root  from  the  ulcerated  area  to  the 
margin  of  the  gum. 

The  treatment  consists  in  the  thorough  removal  of  the  calcic 
deposit  when  present,  and  the  scraping  of  the  root  of  the  tooth 
over  the  entire  ulcerated  surface,  and  the  application  of  anti- 
septic and  astringent  remedies,  such  as  listerine,  aromatic  sul- 
phuric acid,  etc. 

Maxillary  Abscess  may  be  due  to  caries  or  the  diseases  of 
the  teeth,  or  to  pathological  changes  occurring  in  the  structure 
of  the  bone  itself 

Treatment. — The  treatment  of  maxillary  abscess  consists 
either  in  puncture  or  incision,  and  j:he  extraction  of  one  or 
more  of  the  teeth  if  they  are  found  to  be  connected  with  the 
origin  of  the  disease.  If  free  drainage  be  established  by  an 
early  incision,  the  arrest  of  the  disease  is  practically  secured  ; 
it  is  sometimes  necessary  to  remove  a  portion  of  the  alveolar 
process.  The  presence  of  dead  bone  should  be  determined, 
and  such  removed,  with  other  offending  matter.     Free  drain- 


54  DENTAL   MEDICINE. 


age  should  be  maintained  until  complete  recovery  is  brought 
about.  The  abscess  may  be  opened  under  cocaine  anaesthesia, 
a  soft  rubber  drainage  tube  be  inserted,  and  the  cavity  thor- 
oughly irrigated  and  disinfected  with  a  i  to  2,000  bichloride 
of  mercury  solution.  A  safety  pin  may  be  placed  at  the 
external  end  of  the  tube,  and  a  strip  of  iodoform  gauze  put 
between  it  and  the  skin ;  over  this  the  ordinary  bichloride 
gauze  dressing  may  be  secured  by  a  roller  bandage. 

Necrosis  of  the  Alveolar  Process  is  indicated  by  a  dark  purple 
and  swollen  condition  of  gum,  with  offensive  purulent  discharge 
from  one  or  more  fistulous  openings,  or  from  between  the 
gums  and  the  teeth.  The  gum  becomes  soft  and  spongy,  very 
sensitive,  bleeds  readily,  and  loses  its  connection  with  the 
necrosed  bone  beneath. 

Treatment. — (See  Necrosis  of  the  Jaws.) 

Phosphor -Necrosis  is  indicated  by  pain  in  jaw,  similar  to 
odontalg-ia,  at  first  not  constant,  but  soon  becoming  severe, 
and  extending  along  side  of  the  head,  and  to  the  shoulder, 
with  swelling  and  great  tenderness  near  the  seat  of  the  affec- 
tion, the  integument  becoming  red  and  tense,  the  teeth  elon- 
gated and  extremely  painful  when  closed  together,  and  also 
becoming  loose ;  the  gums  and  mucous  membrane  of  the 
cheeks  swollen  and  livid  ;  at  length,  suppuration  ensues,  with 
fever,  rigors,  etc. ;  gums  become  spongy,  with  escape  of  pus 
around  necks  of  necrosed  teeth,  and  the  pus  fetid,  and  the 
swelling  very  great,  especially  when  the  lower  jaw  is  affected; 
a  dense  plastic  exudation  encases  the  under  and  external  sur- 
face of  the  bone;  intense  glistening  redness  of  the  skin,  as  the 
pus  approaches  the  surface ;  at  length,  intense  fever,  with 
delirium  and  great  suffering;  the  throwing  out  of  a  bony 
deposit  of  a  peculiar  appearance,  like  pumice-stone. 

Treatment. — Removal  of  patient  from  exposure  to  fumes 
of  phosphorus,  and  the  excision  of  diseased  portion  of  bone. 

Fracture  of  the  Alveolar  Process  is  indicated  by  a  swollen, 
red  and  painful  state  of  gum  and  tissues  covering  maxillary 
bone,  occurring  some  days  after  the  receipt  of  the  injury,  and, 
if  neglected,  may  result  in  necrosis  of  the  bone. 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  55 

Treatment. — Antiphlogistic  lotions,  to  reduce  the  inflamma- 
tion, such  as — 

R .     Plumbi  acetatis , 5J 

Tinct.  opii §  ss 

Aquse ,^  viij  or  x,     M. 

SiG. — Apply  on  lint. 

Remove  any  detached  portions  of  process,  and  secure  loose 
teeth  with  waxed  sterilized  ligatures. 

Mercurial  Poisoning,  or  Salivation,  when  of  a  mild  form,  is 
indicated  by  a  red  margin  of  the  gum,  which  eventually 
becomes  somewhat  spongy  and  tender,  with  a  slight  fetor  of 
the  breath  and  a  metallic  taste. 

An  increased  degree  of  salivation,  or  mercurial  stomatitis,  is 
indicated  by  a  profuse  flow  of  saliva,  intense  fetor,  strong 
metallic  taste,  tenderness  of  the  gums,  stiffness  of  the  jaws, 
followed  by  ulceration  and  sloughing,  if  the  injudicious  use 
of  the  mercury  is  persisted  in. 

Treatment. — Discontinue  use  of  mercury.  Chlorate  of  pot- 
ash, internally,  gr.  x.,  in  water  oss  :  as  a  gargle,  5j,  to  water 
oj ;  or  iodide  of  potassium  in  doses  of  gr.  iij,  three  times  a 
day.  To  correct  fetor  of  breath,  permanganate  of  potash 
solution,  gr.  ij  to  x,  to  the  ounce  of  water ;  or  washes  of 
chlorinated  soda ;  astringent  washes  during  convalescence. 
Loose  teeth  should  not  be  removed,  as  they  will  again  become 
firm. 

Lead  Poisoning  is  indicated  by  a  blue  line  upon  the  edge  of 
the  gums,  and  such  constitutional  symptoms  as  paralysis  and 
colic  attend  severe  cases. 

Treatment. — Administration  of  iodide  of  potassium  in  gr.  iij 
doses,  four  times  a  day,  after  meals,  to  eliminate  the  lead  ; 
saline  cathartics,  electricity,  strychnine,  etc.,  for  the  paralysis, 
and  tonics,  such  as  quinine,  to  promote  the  strength. 

Scurvy  is  indicated  by  a  general  spongy  condition  of  the 
gums,  and,  in  severe  cases,  intense  fetor,  ulceration  and  slough- 
ing together  with  constitutional  symptoms  of  an  aggravated 
character.     The    premonitory   symptoms   in   the   mouth    are, 


56  DENTAL   MEDICINE. 


gums  paler  than  usual,  with  a  slight  tumid  or  everted  line  on 
free  margins,  and  slight  tenderness  on  pressure ;  breath  offen- 
sive, and  a  disagreeable  taste  ;  tongue  flabby  and  larger,  though 
clean  and  pale.  Later,  the  gums  become  darkened  in  color, 
inflamed,  swollen,  spongy,  bleed  readily,  and  finally  separate 
from  the  teeth.  The  gums  of  edentulous  jaws  do  not  present 
these  symptoms.  At  length,  the  gums  present  great,  fungous, 
lacerable  excrescences,  which  are  prone  to  suppurate  and 
become  a  brown,  fetid  mass,  with  a  very  offensive  odor.  The 
salivary  glands  become  enlarged  and  swollen  ;  tongue  indented 
by  the  teeth,  which  latter  become  coated  with  a  salivary  deposit, 
and  finally  drop  out.  Necrosis  and  extensive  exfoliation  of 
the  bones  of  the  jaw  may  occur.  Some  varieties  of  salivary 
calculus  will  produce  similar  local  symptoms,  especially  when 
the  general  condition  of  the  system  is  unfavorable. 

Treatment. — Change  of  diet,  substituting  fresh  meats,  soups, 
nitrogenous  food,  and  recent  vegetable  acids,  as  citric,  tartaric, 
and  acetic,  and  these  combined  with  potassium.  Nitrate  of 
potassium,  either  alone  or  mixed  with  vinegar,  as  an  anti- 
scorbutic. 

A  Simple  Form  of  Stomatitis  is  indicated  by  slightly  elevated, 
reddish,  glistening  patches  on  the  mucous  membrane,  which 
may  coalesce,  so  that  the  whole  surface  is  involved. 

Treatment. — Emollient  and  detergent  lotions,  such  as  slip- 
pery-elm bark,  pith  of  sassafras,  or  borax,  5j,  glycerine,  oj,  or, 
borax,  5j,  honey,  5iij,  or  a  weak  solution  of  alum,  or  acetate  of 
lead,  gr.  iij  to  the  ounce  of  water.  A  few  doses  -of  bromide 
of  potassium  will  relieve  the  nervous  excitement.  Chlorate 
of  potash  lotion,  gr.  v  to  the  ounce  of  water,  is  also  efficacious 
as  a  local  remedy. 

Suppurative  Gingivitis.  —  Dr.  Ottoleng'ui  recommends  for 
this  affection  spraying  the  gingivae  with  a  three  per  cent, 
solution  of  pyrozone ;  then  remove  all  deposits  thoroughly ; 
for  virulent  cases  he  employs  a  five  per  cent,  solution,  and 
sometimes  a  twenty-five  per  cent,  solution.  Pain  following 
the  application  of  the  pyrozone  may  be  relieved  by  applying 
glycerole  of  tannin.     This  treatment  is  to  be  resorted  to  twice 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  57 


a  week,  using  the  three  per  cent,  solution  of  pyrozone  as  a 
mouth-wash  during  this  time.  Where  sensitiveness  about 
necks  of  teeth  or  elsewhere  is  caused  by  the  one-twentieth  of 
one  per  cent,  of  acidity  of  the  pyrozone,  it  may  be  neutralized 
by  placing  a  small  particle  of  carbonate  of  magnesia  in  the 
tumbler,  and  then  pouring  in  the  three  per  cent,  solution  of 
pyrozone  to  be  used. 

Ulcerous  Stomatitis,  common  to  childhood,  is  indicated  by 
ulceration  commencing  on  or  near  the  gums,  more  frequently 
in  the  lower  than  in  the  upper  jaw,  and  usually  on  one  side 
only,  and  spreading  over  the  entire  mouth.  The  gum  first 
becomes  thickened  and  congested,  and  of  a  deep  purple  color, 
and  bleeds  readily ;  ulceration  speedily  occurs,  and  exposes 
the  necks  of  the  teeth,  and  extends  to  the  mucous  membrane 
of  the  mouth  generally,  the  ulcerated  surface  being  covered 
with  a  dirty  white  or  yellow  exudation,  leaving  exposed 
numerous  bright  red  points  on  a  yellowish  ground.  The 
edges  of  the  ulcers  are  sharp  and  ragged,  and  the  ulcer,  at 
first  superficial,  becomes  gradually  deeper.  Ulcers  of  the 
mouth  are  often  due  to  syphilis  and  dyspepsia,  and  are  aggra- 
vated by  the  irritation  resulting  from  the  irregular  edges  of 
fractured  and  decayed  teeth.  When  neglected,  such  ulcers 
may  assume  the  appearance  of  epithelioma,  especially  when 
induration  of  the  glands  beneath  the  jaw  is  present. 

Treatment.  —  Remove  all  apparent  causes  of  irritation. 
Change  diet  and  residence,  if  at  fault,  observe  cleanliness, 
administer  tonics,  as  liquor  ferri  nitratis  with  tincture  of 
calumba.  Local  applications  of  nitrate  of  silver,  gr.j  to  iij  to 
the  ounce  of  water,  or  diluted  muriatic  acid,  alternating  with 
a  lotion  of  equal  parts  of  borax  and  honey,  or  chloride  of 
lime,  5j,  honey  oj ;  also,  pyrozone  three  per  cent,  europhen 
combined  with  lanolin,  phenosalyl,  glycozone,  etc.  Chlorate 
of  potash  internally,  in  doses  of  5ij  or  iij,  and  also  as  a  lotion, 
is  efficacious ;  also,  a  strong  solution  of  borax,  in  obstinate 
cases,  gr.  xv  to  the  ounce  of  water ;  also,  a  solution  of  sulphate 
of  copper. 

Ulcers  of  the  Mouth  due  to  Syphilis  are  indicated  when  such 


58  DENTAL   MEDICINE. 


ulceration  is  obstinate  under  any  but  specific  treatment,  and 
when  accompanied  by  symptoms  peculiar  to  syphilis. 

Treatment.  —  Constitutional  treatment  with  mercury  or 
iodide  of  potassium,  and  such  local  remedies  as  are  employed 
in  ulcerous  stomatitis. 

Syphilitic  Inflammation  of  the  Mucous  Membrane  of  the 
Mouth  is  indicated  by  a  general  swelling  of  the  gums,  with 
everted  and  ulcerated  margins,  exposing  the  necks  of  the 
teeth,  although  not  affecting,  to  any  great  degree,  their  sta- 
bility, with  a  viscid  discharge,  mixed  with  blood,  from  about 
their  necks;  soreness  rendering  mastication  painful;  the 
affection  slowly  spreading  until  the  bone  is  exposed  and  a 
portion  exfoliated ;  greater  degree  of  congestion ;  formation 
of  mucous  patches  on  sides  of  cheeks ;  superficial  ulcers 
inside  of  cheeks  and  beneath  the  tongue ;  erosions  of  the  soft 
palate  and  tonsils ;  fissures  at  corner  of  the  mouth  and  erup- 
tions on  skin  and  scalp. 

Treatment. — (See  Ulcers  of  the  Mouth  due  to  Syphilis.) 

Gangrenous  Stomatitis,  common  to  children  during  the 
shedding  of  the  temporary  teeth,  is  indicated  by  a  thick  swell- 
ing of  the  face ;  skin  tense  and  shining ;  swelling  becoming 
hard  and  circumscribed,  but  devoid  of  tenderness,  with  a 
central  spot,  red  and  variegated  in  appearance ;  the  formation 
of  an  ulcer,  corresponding  to  the  red  spot  outside,  on  the 
inside  of  the  cheek ;  profuse  salivation,  the  ulcerated  part 
becoming  gangrenous,  with  an  opening  through  the  cheek ; 
absence  of  pain  and  destruction  of  parts. 

Treatment. — Preventive:  Pure  air,  cleanliness,  nourishing 
diet,  sulphate  of  quinine,  internally,  in  doses  of  gr.  ij  to  iij  ; 
and  as  a  lotion,  sulphate  of  zinc,  5j  to  the  ounce  of  water. 
When  the  disease  is  established,  the  local  use  of  escharotics — 
as  acetic,  sulphuric,  nitric,  hydrochloric  acids,  nitrate  of  silver, 
acid  nitrate  of  mercury,  or  chloride  of  antimony — each  applied 
by  means  of  a  camel-hair  brush  to  gangrenous  part,  and  at 
once  followed  by  the  application  of  dry  chloride  of  lime.  The 
mouth  to  be  washed  out  with  tepid  water,  by  means  of  a 
syringe.     After  the  separation  of  the  slough,  the  dry  chloride 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  59 

of  lime  alone  may  be  used.  The  muriated  tincture  of  iron  is 
also  employed ;  and  after  the  gangrene  is  arrested,  astringent 
lotions  are  efficacious. 

Scrofula. — In  early  life  the  characteristics  are  most  apparent. 
Tendency  to  enlargement  of  lymphatic  glands ;  proclivity  to 
certain  forms  of  skin  eruption ;  to  disease  of  the  joints  and 
bones ;  the  efforts  necessary  for  growth  and  development 
overtax  the  defective  vital  powers ;  defective  quality  of  the 
blood  and  tissues,  and  especially  of  the  vascular  tissue ;  in- 
juries, such  as  sprains,  end  in  chronic  disease  of  the  joint.  A 
scrofulous  child  may  grow  finely  for  several  years,  and  then, 
without  adequate  cause,  be  overtaken  by  meningitis  or  disease 
of  vertebrae  :  inflammations  are  prone  to  take  on  chronic 
form. 

Treatment. — Pure  air  of  country,  cod-liver  oil  and  malt, 
iron  and  hypophosphites  to  increase  the  quantity  of  nutritious 
constituents  of  the  blood. 

A  Tumor  of  the  Upper  Jaw  is  indicated  by  a  gradually 
increasing  prominence  of  the  cheek,  which  more  or  less 
involves  the  mouth,  obstructing  the  nostril,  causing  double 
vision  by  displacing  the  eyeball. 

Treatment. — Removal  by  a  surgical  operation, 

A  Malignant  Form  of  Tumor  of  the  Jaws  is  indicated  by  a 
solid  prominence,  rapid  in  growth,  and  having  a  tendency  to 
invade  surrounding  structures,  and  to  fungate  like  a  mush- 
room. 

Treatment. — Removal  by  a  surgical  operation,  and  the  ap- 
plication of  escharotics,  as  chromic  acid,  or  chloride  of  zinc, 
etc.,  to  prevent  its  reproduction. 

A  Dentigcrous  Cyst. — Cysts  of  the  teeth  are  of  two  kinds — 
those  connected  with  the  roots  of  developed  or  eruptive  teeth, 
and  those  connected  with  imperfectly  developed  or  unerupted 
teeth, and  both  varieties  are  common  to  either  jaw;  the  latter, 
however,  are  known  as  "  dentigerous  cysts."  A  dentigerous 
cyst  is  indicated  by  the  expansion  of  the  bone  of  the  jaw  at 
some  particular  spot,  with  disfigurement  of  the  adjacent  parts  ; 
a  sense  of  weight  and  tension  in  the  affected  part;  in  some 


60  DENTAL   MEDICINE. 


cases,  constitutional  irritation  from  pressure  ;  pressure  pro- 
ducing a  parchment-like  crackle  or  crepitation ;  absence  of  a 
tooth,  which  has  never  been  erupted  nor  extracted.  Heath 
remarks  that  "  the  clinical  history  of  cysts  connected  with  the 
teeth  is  that  of  painless  expansion  of  the  alveolus  of  either 
jaw,  but  more  frequently  of  the  upper,  with  crackling  of  the 
bone  on  pressure,  and  ultimate  absorption  of  the  bony  wall. 
The  cyst  then  presents  a  bluish  appearance  through  the  dis- 
tended mucous  membrane,  and  if  large,  gives  distinct  evidence 
of  fluctuation. 

Treatment. — A  free  incision,  and  the  removal  of  the  un- 
erupted  tooth  by  destroying  the  front  wall  of  the  cyst,  and 
the  cavity  filled  with  lint,  so  as  to  induce  granulation  and 
gradual  obliteration.  In  the  case  of  a  cyst  of  the  lower  jaw, 
after  the  removal  of  the  contents  and  a  portion  of  the  walL 
the  plates  of  bone  should  be  pressed  together  as  much  as 
is  possible. 

An  Unerupted  hnpacted  Tooth  is  indicated  by  a  hard,  bony 
tumor  on  the  alveolar  ridge,  sometimes  extending  along  the 
surface  of  the  palate  bone,  or  the  body  of  the  maxilla,  and  in 
form  corresponding  to  a  tooth,  the  absence  of  which  is  noted. 

Treatment. — Extraction,  by  first  making  an  incision  through 
the  mucous  membrane,  and  then  exposing  the  tooth  by  the 
removal  of  its  bony  capsule. 

Necrosis  of  the  Jaw  is  indicated  by  inflammation  like  that  of 
periodontitis  in  the  early  stage,  but  differing  as  the  disease 
progresses ;  gum  over  affected  part  thickened,  tumid  and  of  a 
red  color ;  pus  oozing  from  the  edge  of  gum,  which  soon 
separates  from  the  alveolus,  the  margins  of  which  become 
exposed;  loosening  and  loss  of  the  teeth;  the  detachment  of 
the  dead  alveoli  from  the  living  bone,  and  remaining  loose 
in  the  substance  of  the  thickened  gum  which  becomes  dark 
in  color,  surrounded  by  pus  ;  the  escape  of  the  pus  into  the 
mouth,  or  pointing  below  the  chin,  or  beneath  the  fascia  of 
the  neck,  as  low,  at  times,  as  the  clavicle. 

Treatment.  —  Remove  the  dead  portions  from  the  living 
bone.     Syringe  with   peroxide   of   hydrogen    to   cleanse    the 


DIAGNt)SIS   OF   MOUTH   AFFECTIONS.  61 

part,  and  use  chlorinated  washes,  such  as  chloride  of  soda  or 
permanganate  of  potash,  to  correct  the  offensive  odor  and  dis- 
agreeable taste.  Make  daily  applications  of  dilute  aromatic 
sulphuric  acid,  adding  to  the  acid  a  few  drops  of  the  tincture 
of  capsicum  for  its  stimulating  effect;  diluted  carbolic  acid, 
tincture  of  iodine  and  chloride  of  zinc,  sulphate  of  copper, 
listerine  and  ethereal  solution  of  iodoform,  aristol,  etc.,  are 
also  used  as  applications.  Support  the  strength  by  stimulants, 
tonics  and  nourishing  diet.  For  a  dead  bone  solvent,  wash 
out  the  sinus  with  peroxide  of  hydrogen,  and  inject  into  it  the 
following,  twice  a  day,  so  that  it  will  come  in  contact  with  the 
dead  bone  :  Pure  scale  pepsin,  5ss ;  nitro-muriatic  acid,  §j  ; 
distilled  water,  Oj. 

Dislocation  of  the  Lower  Jaw,  when  double,  is  indicated  by 
inability  to  close  the  mouth  ;  the  mouth  widely  open  ;  the 
chin  prominent,  with  a  distinct  hollow  in  front  of  each  ear. 
A  single  dislocation  is  indicated  by  the  mouth  being  only  par- 
tially open,  the  chin  displaced  to  one  side,  the  distinct  hollow 
below  the  ear  being  on  the  opposite  side. 

Treatment. — Reduction  is  made  by  placing  the  thumbs, 
protected  by  napkins,  as  far  back  upon  the  molars  as  possible, 
and  then  depressing  the  back  part  of  the  jaw,  and  at  the  same 
time  raising  the  chin.  The  jaws  should  afterward  be  secured 
by  a  bandage  extending  under  the  chin  and  over  top  of  head. 

Fracture  of  the  Lower  Jazv  is  indicated  by  inability  to  close 
the  mouth,  and  to  speak  articulately ;  laceration  of  the  gums 
and  hemorrhage  ;  irregularity  of  the  teeth  from  displacement 
of  the  fragments  of  bone  ;  crepitation.  Fracture  of  the  max- 
illa may,  however,  show  no  displacement,  or  the  fracture  ex- 
tending through  the  angle  or  ramus,  may  be  diagnosed  by 
grasping  the  two  sides  of  the  jaw  and  moving  them  forcibly. 
Crepitus,  increased  flow  of  saliva,  mobility  of  fragments,  and 
irregularity  of  the  teeth,  if  the  fracture  is  through  the  body 
of  the  bone,  are  all  signs  of  fracture.  A  swollen,  red  and 
painful  condition  of  the  tissues  covering  the  lower  jaw,  occur- 
ring some  days  after  the   accident,  denote  the  possibility  of 


62  DENTAL   MEDICINE. 


fracture,  neglect  causing  a  high  degree  of  inflammation,  and 
in  some  cases  even  necrosis  of  the  bone. 

Treatme7it. — Reduce  by  bringing  the  displaced  portions  into 
apposition,  being  guided  by  the  arch  of  the  teeth,  and  then 
securing  them  by  wire,  silk,  or  waxed  sterilized  ligatures 
around  the  teeth,  and  introducing  an  interdental  splint. 

Cleft  Palate  is  indicated  by  a  fissure  extending  through  the 
soft  palate  alone,  or  through  both  soft  and  hard  palates,  and 
which  may  be  combined  with  single  or  double  hare-lip,  in 
which  case  the  intermaxillary  bones  are  frequently  displaced. 

Treatment. — When  the  cleft  is  confined  to  the  soft  palate, 
the  operation  of  staphylorraphy  may  be  performed  ;  when, 
however,  the  cleft  is  through  both  soft  and  hard  palates,  the 
construction  of  an  artificial  obturator  and  palate  combined  will 
often  prove  successful  in  correcting  the  voice  and  preventing 
much  inconvenience  in  partaking  of  food  and  drink. 

Hare-lip  is  indicated  by  a  congenital  fissure  of  the  upper 
lip,  and  may  be  single  or  double,  and  may  also  be  complicated 
with  fissure  of  the  hard  and  soft  palates. 

Treatment. — Pare  the  surfaces  of  the  edges  of  the  fissure 
in  such  a  manner  as  will  allow  a  flap  on  one  to  cover  the  edge 
of  the  other  when  they  are  brought  in  apposition,  when  they 
are  secured  by  the  aid  of  pins  and  the  figure-of-eight  suture, 
which,  in  the  case  of  infants,  may  be  preserved  from  injury  by 
passing  a  silver  wire  through  the  cheeks,  having  on  each  pro- 
truding end  a  button,  to  prevent  the  breaking  up  of  the  suture' 
during  the  act  of  crying.  Cocaine  is  a  useful  local  anaesthetic 
for  such  operations. 

Facial  Paralysis  is  indicated  by  distortion  of  the  face,  in 
which  the  mouth  is  drawn  to  one  side,  being  due  to  paralysis 
of  the  facial  nerve.  The  eye  may  also  remain  permanently 
open  on  the  affected  side,  the  saliva  escape  from  the  corner  of 
the  mouth,  and  the  food  collect  under  the  cheek,  on  account 
of  the  paralysis  of  the  buccinator  muscle. 

Treatment. — Electricity,  and  systematic  treatment  with 
strychnine,  phosphorous,  iron,  quinine,  ergot,  etc. 

A  Nasal  Polypus  is  indicated  by  more  or  less  obstruction  of 


DIAGNOiylS   OF   MOUTH    AFFECTIONS.  63 

one  or  both  nostrils,  with  occasional  watery  discharge  ;  a  gray 
or  yellowish  mass,  like  jelly  in  consistence,  can  be  detected 
by  the  finger,  if  it  is  passed  behind  the  soft  palate,  hanging 
down  into  the  pharynx,  and  which  greatly  increases  in  damp 
weather;  the  nose  bulged  out  on  one  side  by  the  growth 
within. 

Treatment. — Remove  either  by  the  snare  or  by  torsion, 
or  by  repeated  applications  of  chromic  acid.  To  prevent 
reproduction  apply  to  the  surface  chromic  acid  or  chloride  of 
zinc. 

TJiviish,  common  to  infants  and  children  under  eighteen 
months  of  age,  is  indicated  by  small,  white  spots,  the  size  of  a 
pin's  head,  upon  the  dorsal  surface  of  the  tongue,  palate,  velum, 
inside  of  cheek  and  lips,  which  increase  in  size  and  coalesce, 
with  a  tendency  to  false  membrane,  the  crusts  falling  off  and 
reappearing;  the  mucous  membrane  beneath  redder  than 
natural. 

Treatment. — Change  of  diet  and  residence,  if  these  are  at 
fault ;  the  administration  of  saccharate  of  lime  in  milk.  Local 
treatment,  mel-boracis,  or  borax  solution,  or — 

B  .     Sodii  borat ^j 

Glycerinse c    .    .    .      ^ij 

Aquse ^^iv.  M. 

SiG. — Apply  with  a  camel's-hair  brush  four  or  five  times  a  day. 

Or— 

R .     Zinc  sulph gr.ij-iv 

Aquae  rosse  ^ij.    M. 

Or  a  weak  solution  of  nitrate  of  silver. 

AphthcE  or  Follicular  Ulceration,  common  to  childhood,  is 
indicated  by  the  mucous  membrane  becoming  inflamed,  and 
the  formation  of  small,  round,  transparent  vesicles  on  the 
frsenum,  in  the  sulcus  between  the  lips  and  gums,  and  on  lower 
surface  of  tongue.  On  the  bursting  of  the  vesicles,  small, 
spreading  ulcers,  with  red  and  swollen  margins,  appear,  which 
become  coated  with  a  layer  of  o'idium  albicans. 

^reatmeiit. — Demulcent    applications,  such  as  mucilage  of 


64  DENTAL   MEDICINE. 


gum  acacia,  or  flaxseed.  Mel-boracis  applied  with  a  camel's- 
hair  brush.  For  constitutional  symptoms,  administer  laxa- 
tives and  the  bromides,  with  warm  foot  bath. 

Epulis  is  indicated  by  a  growth  on  the  gums,  either  small 
and  pedunculated,  or  large  and  sessile. 

If  it  is  firm  in  texture  and  slow  of  growth,  the  epulis  is 
generally  fibrous  ;  but  if  rapid  in  growth  and  dark  in  color,  it 
is  myeloid  ;  if  prone  to  ulcerate  and  very  painful,  it  may  be 
an  epithelioma. 

Treatment. — Removal  of  the  growth,  and  its  reproduction 
prevented  by  the  application  of  nitrate  of  silver,  or  chromic 
acid,  or  a  fire  cautery.  Generally,  it  is  necessary  to  remove 
the  periosteum  and  a  thin  scale  of  the  bone  beneath,  as  this 
growth  is  connected  with  the  periosteum.  Extract  all  roots 
of  carious  teeth,  and  when  the  epulis  is  connected  with  the 
alveolar  cavity  of  a  tooth  and  has  tendency  to  the  interior  of 
the  jaw,  it  is  generally  myeloid,  and  several  teeth  will  have  to 
be  sacrificed,  so  that  the  alveolus  can  be  thoroughly  excava- 
ted. When  very  extensive,  a  considerable  portion  of  the 
alveolus  and  bone  of  the  jaw  must  be  removed. 

Epithelioma  is  indicated  by  a  ragged  ulcer  on  the  lower  lip, 
commencing  as  a  wart,  the  skin  around  being  hard  and  infil- 
trated, with  enlargement  of  the  submaxillary  lymphatic  glands, 
which  become  tender,  or  even  ulcerated. 

Epithelioma  of  the  gum  is  in  the  form  of  a  ragged  ulcera- 
tion, often  the  result  of  irritation  from  diseased  teeth  ;  the  pain 
and  inconvenience  at  first  slight ;  a  tending  of  the  ulceration 
to  spread  toward  the  tongue  and  cheek,  with  induration  of  the 
base  of  the  ulcer. 

Treatment. — Removal  as  soon  as  its  nature  is  manifest.  In 
slight  or  doubtful  cases  the  application  of  the  strongest  nitric 
acid,  the  acid  nitrate  of  mercury,  or  the  actual  cautery,  to 
bring  about  a  healthy  cicatrization.  If  the  disease  has  in- 
volved the  alveolus,  as  is  evident  by  the  swelling  of  the  gum 
and  the  looseness  of  the  teeth,  a  free  removal  of  the  bone  is 
necessary. 

Hypertrophy  of  the  Gums  is  indicated  by  an  increase  of  their 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  65 

substance  to  such  a  degree  as  to  cause  them  to  overhang  and 
cover  the  greater  portion  of  the  crowns  of  the  teeth ;  tendency 
to  hemorrhage ;  gums  dark  and  hvid ;  fetor  of  breath ;  in- 
creased flow  of  saHva. 

Treatment. — Remove  all  dead  teeth  and  salivary  calculus. 
Remove  the  morbid  growth  by  a  horizontal  incision  through 
the  diseased  structure  to  the  crowns  of  the  teeth,  and  freely 
scarify  the  gums  by  passing  a  lancet  between  the  teeth  to  the 
process,  and  repeat  this  operation  at  intervals  of  four  or  five 
days,  if  necessary.  Use  detergent  and  astringent  lotions,  and 
occasionally  a  weak  solution  of  nitrate  of  silver.  Phenate  of 
soda  is  efficacious  as  a  lotion,  also  antiseptic.  Diet  non-irri- 
tating, and  all  excess  and  intemperance  avoided.  The  teeth 
should  be  kept  perfectly  clean. 

Alveolar  Pyurrlicea,  or  Riggs'  Disease,  i"s  indicated  at  first  by 
an  uneasy  sensation ;  then  inflammation  of  margins  of  gums ; 
looseness  of  the  gums  about  the  teeth,  which  form  pockets ; 
and  necrosis  of  edges  of  alveolar  process ;  a  tendency  to 
hemorrhage ;  inflammation  extending  deeper  into  gums  ; 
small  sulci  filled  with  pus ;  looseness  of  the  teeth  and  change 
of  positions ;  disagreeable  taste  ;  peculiar  fetor  of  breath  ; 
dark  livid  color  of  gums,  with  thick  margins,  and  often  ex- 
treme sensitiveness  to  touch ;  in  some  cases  the  gums  are 
denuded  of  their  epithelium,  with  a  polished  appearance,  in 
others,  with  a  pimpled  surface ;  the  teeth,  at  length,  held  in 
their  cavities  by  a  tough,  ligamentous  attachment,  due  to  the 
change  occurring  in  the  peridental  membrane. 

A  simple  form  of  this  disease  may  manifest  itself  at  the 
margin  of  the  gum,  indicating  its  presence  by  a  congested 
appearance,  beneath  which  maybe  found  a  granule  of  calcified 
material.  While  in  many  cases  there  is  general  congestion  of 
the  affected  gum,  and  a  proneness  to  hemorrhage,  in  other 
cases  the  gum  may  present  an  anaemic  appearance — pale  and 
bloodless.  This  disease  may  also  be  associated  with  syphilis, 
mercurial  salivation  and  scurvy.  The  deposit  of  salivary  cal- 
culus or  other  calcified  substance  is  supposed  to  be  secondary 
5 


QQ  DENTAL   MEDICINE. 


to  the  disease,  as  a  deep-red  and   denuded   gum  tissue  about 
the  necks  of  the  teeth  may  be  present  without  any  deposit. 

Dr.  Charles  B.  Atkinson  describes  this  affection  as  follows  : — 
"  Perhaps  the  earliest  condition  presented  to  us  is  a  tumefac- 
tion of  the  margin  of  the  gum — from  pearly-red  and  light  lilac 
to  purplish-blue  in  tint — sometimes  puffing  to  such  an  extent 
as  to  be  easily  confounded  with  an  alveolar  abscess.  The 
tumefied  gum  bleeds  readily  on  brushing.  A  probe  passed 
carefully  under  the  gum  will  disclose  a  pocket  embracing  more 
or  less  the  circumference  of  the  root,  in  some  places  nearly  or 
quite  to  its  apical  end.  Sometimes  the  gum  will  be  found  re- 
ceded, perhaps  on  one  side  only.  A  purulent  discharge  more 
or  less  marked,  may  be  demonstrated  by  pressure  of  the  finger 
over  the  root,  from  its  end  towards  the  crown  of  the  tooth.  A 
further  demonstration  of  the  pressure  of  pus  may  be  secured 
by  injection,  about  the  necks  of  the  teeth,  of  peroxide  of  hy- 
drogen. A  general  hypertrophy  of  the  oral  tissues  may  be 
noticed.  Suppuration,  perhaps  preceding,  perhaps  following, 
a  solution  of  the  dental  ligament,  which  permits  the  pocket  to 
be  formed,  and  is  the  antecedent  usually  responsible  for  the 
loosening  of  the  teeth.  This  loosening,  may,  however,  be  pre- 
sent as  a  result  of  inflammation  before  suppuration  has  suc- 
ceeded. The  loosening  may  be  attended  with  recession  of  the 
gum  or  not,  and  with  or  without  pain.  Locally,  aside  from 
the  gingival  congestions  already  noticed,  the  teeth  may  be 
found  elongated,  the  breath  fetid,  tartar  freely  present  (although 
many  cases  progress  to  disaster  with  no  appreciable  deposit  of 
tartar),  pus  sometimes  oozing  from  the  sockets,  putrid  taste  in 
the  mouthj  tenderness  of  the  teeth,  already  noted,  and  many 
times  considerable  irregularities,  the  natural  result  of  the 
loosening  of  the  teeth.  Observation  may  disclose  such  sys- 
temic conditions  as  stomach  dyspepsia,  catarrh  (as  nasal  ca- 
tarrh or  other  mucous  surface  debility),  constipation,  phthisis, 
adenoid  growths,  general  congestion  due  to  intemperance, 
kidney  disease,  rheumatism,  cold  feet  and  other  extremities, 
indicating  poor  circulation  and  mal-assimilation.     Dr.  Rhein 


DIAGNOSIS   OF   MOUTH  AFFECTIONS.  67 

has  truly  said  that  incurable  systemic  disorders  make  only 
palliation  of  pyorrhoea  disorders." 

Treatment. — The  first  and  most  important  matter  is  to 
remove  all  deposits  fi-om  the  roots  of  the  teeth,  and  all 
necrosed  bone  from  the  margins  of  the  alveolar  processes. 
This  can  be  accomplished  with  what  are  known  as  Riggs'  in- 
struments. An  acquired  and  acute  sense  of  touch  is  necessary 
to  determine  the  thoroughness  of  the  cleansing  operation. 
The  pockets  formed  in  the  gum  may  then  be  treated  with 
iodoform  and  eucalyptus,  iodoform  and  oil  of  cinnamon,  or 
with  injections  of  chloride  of  alumina,  gr.  iij  to  the  ounce  of 
water,  also  strong  tincture  of  myrrh,  aromatic  sulphuric  acid, 
nitrate  of  silver.  Peroxide  of  hydrogen,  and  also  a  solution 
of  iodide  of  zinc,  gr.  xii-xiv  to  the  ounce  of  water,  are  also  re- 
commended by  Dr.  Harlan,  in  the  form  of  injections  ;  and  for 
chronic  cases  the  latter  in  a  solution  composed  of  gr.  xxiv  to 
the  ounce  of  water,  after  the  parts  are  cleansed  by  injections 
of  the  peroxide  of  hydrogen.  Another  method  :  After 
thorough  removal  of  deposits,  syringe  with  aromatic 
sulphuric  acid,  diluted  with  one-half  water,  and  apply 
night  and  morning  a  powder  composed  of  creta  preparatse, 
5j  ;  acidum  boricum,  5J.  The  use  of  "  Robinson's  Remedy" 
is  also  recommended,  followins;  the  use  of  bichloride  of  mer- 
cury  I  to  500. 

Dr.  Chas.  B.  Atkinson  recommends  first  returning  loose 
teeth  to  place  laterally,  and  securing  them  with  waxed  steril- 
ized ligatures.  Then,  beginning  with  the  upper  jaw,  such  scal- 
ing as  may  be  indicated  should  be  performed,  after  which  the 
pockets  should  be  carefully  investigated  with  proper  instru- 
ments, all  foreign  matter  removed  from  them  and  from  about 
the  teeth,  having  recourse  frequently  to  a  -siir  or  TaVir  solution 
of  HgClg  in  H2O2.  This  preparation  of  peroxide  should  be 
first  allowed  to  remain  in  the  pockets  and  about  the  teeth  for 
perhaps  even  three  minutes.  It  may  be  necessary  to  reduce 
the  length  of  elongated  teeth,  but  if  direct  pressure  will  answer, 
this  should  be  resorted  to  and  shortening  of  the  bite  avoided. 
See  the  patient  daily  for  two  weeks.     Sometimes  no  applica- 


68  DENTAL   MEDICINE. 


tion  of  medicaments  will  be  indicated — perhaps  a  little  scaling 
or  scraping  of  overlooked  deposit,  from  time  to  time. 
The  appearances  of  the  abnormal  conditions  seem  to  be  best 
indicated  by  color,  size  and  texture.  A  dark  blue  color  of 
soft  and  spongy  gum  should  be  lanced  to  relieve  the  venous 
congestion,  and  then  injected  with  aromatic  sulphuric  acid, 
full  officinal  strength.  Should  suppuration  be  imminent  or 
present,  the  pus  should  be  evacuated  by  incision,  or  by  the  in- 
jection of  peroxide  of  hydrogen  as  a  first  step,  followed  by  a 
delicate  apphcation  of  "  caustic  paste  "  (potassa  fusa  ^,  car- 
bolic acid,  cryst.  ^).  A  cherry-red  color  of  slightly  puffed 
gum  calls  for  salicylic  acid  solution  saturated  in  95  per  cent, 
alcohol.  The  constant  exhibition  of  antiseptic  and  stimulant 
mouth-washes  is  necessary,  such  as  combinations  of  bichloride 
of  mercury,  tincture  of  calendula  and  distilled  water,  or  hy- 
dronaphthol,  tincture  of  calendula  and  distilled  water  ;  or  per- 
oxide of  hydrogen  and  tincture  of  calendula.  Systemic 
remedies  are  also  indicated,  such  as  tonics  and  cathartics,  the 
latter  in  the  beginning  of  the  treatment ;  also  digestive  stimu- 
lation. 

Dr.  E.  C.  Kirk  recommends  a  ten  per  cent,  solution  of  aris- 
tol,  rubbed  up  with  oil  of  cinnamon,  or  oil  of  gaultheria  and 
introduced  into  each  suppurating  pocket,  and  around  the  roots 
of  the  teeth  at  the  base  of  each  pocket,  on  wisps  of  absorbent 
cotton,  saturated  with  the  solution ;  also  saturated  solutions 
of  sulphate  of  zinc  and  iodide  of  potassium,  equal  parts,  in 
turn  saturated  with  crystals  of  iodine  ;  also,  pyrozone  five  per 
cent,  solution,  or  peroxide  of  sodium,  or  loretin,  or  trichlora- 
cetic acid  alone  or  in  combination  with  pyrozone,  or  glyco- 
zone.  Dr.  Bodecker  recommends  applying  nitrate  of  silver 
by  making  a  small  platinum  wire  loop,  warming  it,  and  then 
dipping  it  into  powdered  nitrate  of  silver  and  carrying  into 
the  pockets.  Rinsing  the  mouth  before  and  after  the  applica- 
tion with  salt  water  will  prevent  injury  to  surrounding 
tissues. 

Irritation  of  the  Dental  Pulp  is  indicated  by  an  uneasy  sen- 
sation which  develops  into  pain  of  a  gnawing  or  burning  char- 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  69 

acter,  the  affected  tooth  being  sensitive  to  changes  of  temper- 
ature, painful  in  mastication,  but  exhibiting  no  symptoms  of 
inflammation  of  the  gum  or  peridental  membrane. 

Treatment. — The  treatment  must  vary  with  the  condition 
producing  the  affection.  First  remove  all  irritants.  If  the 
cause  is  systemic,  constitutional  treatment  for  the  condition 
present  is  indicated.  Saline  cathartics,  as  the  sulphate  or 
carbonate  of  magnesia  ;  diaphoretics,  as  spts.  mindererus,  or 
Dover's  powder ;  diuretics,  as  preparations  of  nitre,  often  prove 
efficacious ;  also  bromide  of  potassium.  If  the  fluids  of  the 
mouth  are  irritative,  they  must  be  corrected.  If  a  carious 
cavity  exists,  all  foreign  substances  and  the  softer  parts  of 
carious  dentine  should  be  removed,  and  the  cavity  syringed 
with  a  tepid  solution  of  bicarbonate  of  soda,  potash  or  am- 
monia. Dilute  carbolic  acid,  or  wood  creasote,  may  then  be 
applied,  and  a  non-conducting  filling  of  a  solution  of  gutta 
percha  and  chloroform  be  introduced.  (See  Dental  Formulae 
for  Odontalgia  and  Pulpitis.) 

Acute  Inflainination  of  the  Dental  Pulp  is  indicated  by  acute 
pain  in  the  affected  tooth,  which  frequently  extends  to  neigh- 
boring teeth  and  to  the  side  of  the  face,  but  is  more  intense  in 
the  tooth  itself;  pain  may  subside  after  a  few  hours'  duration, 
to  return  again  on  the  slightest  provocation,  or  on  patient 
assuming  a  horizontal  position  ;  the  pain  may  also  assume  a 
throbbing  character. 

Treatment. — The  treatment  of  this  condition  of  pulp  is  indi- 
cated in  that  of  "  irritation  of  the  pulp."  For  soothing  appli- 
cations, solution  of  gutta  percha  and  chloroform,  tincture  of 
hamamelis  applied  warm,  oil  of  cloves,  dilute  creasote,  equal 
parts  of  chloroform,  aconite  and  tincture  of  opium,  may  be 
employed.    (See  Dental  Formulae  for  Pulpitis  and  Odontalgia.) 

CJironic  Inflammation  of  the  Dental  Pulp  is  indicated  by  pam, 
less  severe  than  in  the  acute  form,  and  of  less  duration  ;  coming 
on  at  irregular  intervals,  and  wandering,  like  neuralgic  pains, 
and  incited  by  changes  of  temperature,  and  the  application  of 
irritants.     (See  Irritation  of  Dental  Pulp.) 

Fungous  Growth  of  Pulp  is  indicated  by  the  organ,  as  a  result 


70  DENTAL   MEDICINE. 


of  continued  irritation,  assuming  the  form  of  a  small  vascular 
tumor,  or  granular  mass,  attached  by  means  of  a  pedicle, 
which,  in  some  cases,  completely  fills  the  cavity  of  decay  in 
the  crown  of  the  tooth,  and  is  often  extremely  sensitive  and 
prone  to  hemorrhage. 

Treatment. — When  a  tendency  to  fungous  growth  is  dis- 
covered, the  free  application  of  carbolic  acid  or  tincture  of 
aconite  followed  by  the  use  of  chromic  acid,  will  obtund  the 
sensibility,  when  the  entire  tumor  should  be  excised,  and  its 
reproduction  prevented  by  application  of  nitric  acid  on  a  disc 
of  card-board. 

Ossification  of  the  Dental  Pnlp  is  indicated  by  pain  of  a 
neuralgic  character,  which  commences  in  an  uneasy  feeling, 
and  changes  to  what  has  been  described  as  a  gnawing  sensa- 
tion, similar  to  that  which  attends  the  knitting  together  of  the 
fractured  parts  of  a  bone.  It  may  be  continuous,  but  not  con- 
stantly severe,  and  frequently  amounts  to  no  more  than  an 
uneasy  sensation ;  at  other  times  it  may  be  sharp  and  darting, 
affecting  the  side  of  the  head,  and  all  the  branches  of  the 
superior  maxillary  division  of  the  fifth  pair  of  nerves.  The 
affected  tooth  is  free  from  soreness  and  discoloration. 

Treatment. — Apply  anodynes,  such  as  lead  water,  and  those 
indicated  in  "  acute  inflammation  of  pulp  "  to  relieve  the  pain. 
Open  the  pulp  chamber,  and  completely  extirpate  the  pulp. 

Abnormal  Sejtsibility  of  Dentine  is  indicated  by  pain  resulting 
from  irritation  of  dentinal  structure,  being  of  shorter  duration 
and  less  acute  in  character  than  that  from  an  inflamed  dental 
pulp;  the  pain  of  sensitive  dentine  soon  subsides  on  the 
removal  of  the  irritating  cause. 

Treat7nent. — Apply  obtunding  agents,  as  chloride  of  zinc, 
chloroform  and  aconite  equal  parts,  carvacrol,  oil  of  cloves, 
oil  of  cedar,  oil  of  eucalyptus,  tannin  combined  with  glycerine 
or  camphor,  chloral,  camphorized  ether,  oxide  of  calcium,  car- 
bonate of  sodium,  menthol,  thymol,  sesquichloride  of  chromium, 
sulphate  of  morphine  and  gum  camphor  equal  parts,  ethylate  of 
sodium,  carbonate  of  potash  and  glycerine,  carbolized  potash, 
campho-phenique ;  also  chloride  of  ethyl,  phenate  of  cocaine, 


DIAGNOSIS   OF  MOUTH   AFFECTIONS.  71 

tropacocaine,  peroxide  of  sodium,  etc.  Ottolengui's  method  : 
Apply  the  rubberdam,  dry  cavity  with  bibulous  paper,  then 
insert  a  pledget  of  cotton  saturated  with  absolute  alcohol, 
then  apply  intermittingly  a  series  of  blasts  of  hot  air  to  pro- 
duce evaporation,  until  parts  become  whitened  or  thoroughly 
dry,  then  throw  on  a  continuous  spray  of  ether.  A  jet  of 
nitrous  oxide  gas  directed  into  the  cavity  of  the  tooth  by  a 
piece  of  tubing ;  also  the  vapor  of  alcohol,  produced  by  heat- 
ing the  alcohol  in  a  metal  apparatus,  and  conducting  the  vapor 
into  the  cavity  through  a  fine  metal  tube,  have  also  been  em- 
ployed for  the  relief  of  the  pain  arising  from  hyper-sensitive 
dentine.  The  application  of  cocaine  and  alcohol  by  elec- 
trolysis has  also  given  satisfactory  results.  (See  Therapeutics 
of  Electricity.) 

Abrasion  of  the  Teeth  is  indicated  by  a  loss  of  structure,  due 
to  friction,  to  such  an  extent  at  times  as  to  destroy  the  entire 
crowns. 

Tr£atment.-^Go\d  caps  or  partial  crowns,  either  in  the  form 
of  ferrules  or  contour  fillings,  or  fillings  of  other  metals,  will 
often  arrest  the  process  of  abrasion,  and  render  much  worn 
teeth  useful  organs.  Also  the  insertion  of  artificial  posterior 
teeth  will  often  prevent  natural  front  teeth  from  being  abraded 
from  unnatural  use. 

Hypertrophy  of  the  Alveolar  Processes  is  indicated  by  an 
osseous  deposit,  either  at  the  apex  of  the  alveolar  cavity,  in 
which  case  the  affected  tooth  is  protruded  from  its  cavity,  or 
by  a  deposit  of  osseous  matter  on  the  wall  of  the  alveolar 
cavity,  in  which  case  the  tooth  is  forced  to  one  side. 

Treatineiit.—  When  the  osseous  deposit  is  in  the  bottom  of 
the  alveolar  cavity,  the  length  of  the  tooth  may  be  reduced 
from  time  to  time  until  a  certain  degree  is  reached,  when  the 
loss  of  the  tooth  is  inevitable.  When  the  deposit  is  upon  the 
side  of  the  cavity,  the  effect  is  irregularity  or  malposition,  for 
which  there  is  often  no  remedy  but  the  removal  of  the  devi- 
ating tooth. 

Hyperceuientosis  or  Dental  Exostosis  is  indicated  by  an  uneasy 
sensation  in  the  affected  tooth,  followed  by  a  gnawing  pain. 


72  DENTAL  MEDICINE. 


which  in  some  cases,  assumes  a  severe  neuralgic  character, 
especially  when  the  deposit  of  cementum  on  the  root  is  of 
considerable  size,  in  which  case  there  is  a  prominence  appar- 
ent on  the  side  of  the  alveolar  ridge. 

Treatment. — During  the  early  stages  of  this  affection,  the 
administration  of  large  doses  of  iodide  of  potassium,  and  the 
application  of  counter-irritants,  such  as  a  saturated  tincture  of 
iodine  or  cantharidal  collodion,  have  been  suggested,  to  arrest 
the  deposit  and  cause  absorption.  When  the  deposit  is  large 
and  productive  of  pain  and  inconvenience,  the  removal  of  the 
affected  tooth  is  inevitable. 

Edentulous  Neuralgia. — Caused  by  hypertrophy  of  the  in- 
ferior dental  nerve  in  aged  persons  in  the  absence  of  all  the 
teeth,  after  the  nerve  makes  its  exit  through  the  dental  fora- 
men. The  remedy  is  a  saddle-shaped  plate  for  the  artificial 
denture  worn,  so  that  the  pressure  is  distributed  to  surround- 
ing parts  and  not  exerted  upon  the  nerve  as  it  passes  out  of 
the  foramen. 

Organic  Defects  of  Structure,  indicated  by  defects  in  the 
enamel,  in  the  form  of  opaque  spots,  grooves  or  pits,  congenital 
in  origin,  and  due  to  altered  functions  from  impaired  nutrition. 

Treatment. — Preventive  by  mitigating  severity  of  diseases 
producing  the  condition,  by  the  administration  of  proper 
remedies.     For  the  pitting  variety,  properly  inserted  fillings. 

Odontomes  are  indicated  by  irregular  masses  of  dental  tis- 
sues, which  result  from  morbid  conditions  of  the  formative 
pulp,  such  as  nodules  of  enamel  and  dentine,  hypertrophy  of 
cementum,  etc.,  some  being  congenital,  others  induced. 

Treatment. — Extraction,  when  they  are  a  source  of  irritation, 
or  an  injury  to  the  normal  teeth,  or  are  unsightly. 

Syphilitic  Teeth  are  indicated  by  notches,  generally  cres- 
centic,  in  the  cutting  edges  of  the  incisors,  and  peg-like  shaped 
cuspids  ;  also,  a  dark  color  and  soft  consistence  are  character- 
istic of  such  teeth. 

Treatment. — The  most  skillful  treatment  by  properly  intro- 
duced fillings  and  constant  attention,  are  necessary  for  their 
preservation. 


DIAGNOSIS  OF  MOUTH  AFFECTIONS.  73 

Erosion  of  the  Teeth  is  indicated  by  the  gradual  destruction 
of  the  enamel  of  the  labial  surfaces  of  the  incisors,  canines, 
and  sometimes  of  the  bicuspids,  generally  in  the  form  of  a 
continuous  horizontal  groove,  smooth  and  regular ;  in  some 
cases  it  may  extend  over  nearly  the  whole  of  the  labial  sur- 
face, the  color  of  the  enamel  being  rarely  changed.  Erosion 
is  the  removal  of  the  surface  of  the  enamel,  without  apparent 
cause,  its  first  appearance  consisting  of  a  slight  cup-  or  dish- 
shaped  cavity  in  the  enamel  a  short  distance  from  the  margin 
of  the  gum,  usually  on  the  anterior  surfaces  of  the  front  teeth, 
although  it  is  not  confined  to  such  teeth,  the  small  excava- 
tions .gradually  broadening  and  deepening  until  the  surface  of 
the  dentine  becomes  exposed,  which  remains  hard  and  finely 
polished;  and  a  pit  or  groove  is  at  length  formed  which 
gradually  widens  and  deepens  until  a  considerable  portion  of 
the  crown  of  the  tooth  is  destroyed.  True  erosion  differs 
from  the  destruction  of  the  enamel  in  the  form  of  pits  and 
irregularities  due  to  an  acid  condition  of  the  •  fluids  of  the 
mouth,  lactic  acid  being  a  prominent  factor  in  promoting  fer- 
mentative action. 

Treatment. — In  advanced  stages,  arrest  its  progress  by  fill- 
ings of  durable  material. 

Absorption  of  Process  and  Recessio7t  of  Gum  is  indicated  by 
a  slight  increase  of  redness,  some  congestion  and  a  shrinkage 
of  the  margins  of  the  gums,  and  may  be  accompanied  with  a 
slight  purulent  discharge  about  the  neck  of  the  affected  tooth. 
The  symptoms  resemble  those  of  chronic  inflammation  of  the 
gums.  The  progress  of  the  affection  is  generally  slow,  and  it  is 
often  first  observed  about  the  necks  of  the  canine  teeth.  Teeth 
so  affected  become  more  susceptible  to  impressions  of  heat, 
colds,  acids,  etc.,  and  eventually  loose. 

Treatment. — To  arrest  the  progress  of  this  affection,  first 
remove  all  irritants,  and  cleanse  thoroughly,  polishing  the  ex- 
posed surfaces.  Correct  the  nature  of  the  fluids  of  the  mouth, 
if  at  fault,  by  constitutional  treatment,  the  use  of  alkaline 
lotions,  such  as  lime  water,  and  detergent  dentifrices.  Such 
agents   as   a  weak  solution  of  chloride  of  zinc,   to  produce 


74  DENTAL   MEDICINE. 


healthy  granulation,  carbolic  acid,  nitrate  of  silver,  and  judi- 
cious pressure,  maybe  employed  with  advantage.  A  moderately 
stiff  brush  and  floss  silk  are  useful  adjuncts  to  the  treatment. 

Necrosed  Teeth. — The  term  "  necrosed  "  is  applied  to  a  tooth 
when  the  vitality  of  its  pulp  and  lining  membrane  is  destroyed, 
the  peridental  membrane,  however,  maintaining  a  degree  of 
vitality  which  prevents  the  tooth  from  becoming  an  irritant, 
so  as  to  insure  its  loss  as  an  effete  organ. 

Treatment. — When  a  necrosed  tooth  is  not  productive  of 
injury  to  the  adjacent  structures,  and  there  is  a  probability  of 
rendering  it  a  useful  organ,  the  pulp  canal  should  be  thor- 
oughly exposed,  cleansed,  and  treated,  if  necessary,  with  dis- 
infectants, antiseptics,  etc.,  and  then  filled,  together  with  the 
crown  cavity,  with  a  suitable  material.  As  necrosed  teeth 
are  frequently  considerably  discolored,  on  account  of  the 
tubuli  of  the  dentine  absorbing  coloring  matter  from  the  dead 
pulp,  such  bleaching  agents  as  chloride  of  lime,  chloride  of 
alumina,  oxalic  acid,  chloride  of  soda,  sulphite  of  soda  com- 
bined with  boracic  acid,  cyanide  of  potassium,  tartaric  acid  in 
combination  with  chloride  of  lime,  chloride  of  zinc,  also  alum 
in  combination  with  liq.  sodse  chlorinatse,  may  be  employed 
to  improve  their  appearance,  also  use  of  nitrous  oxide  in  com- 
bination with  chloride  of  sodium,  also  peroxide  of  hydrogen. 

Infantile  Paralysis  During  the  Period  of  TeetJdng. — Infantile 
paralysis,  or  poliomyelitis,  is  an  obscure  affection  peculiar 
to  a  certain  season,  which  has  given  to  it  at  the  hands  of  some 
the  name  of  "  warm  weather  spinal  disease."  It  comes  on 
suddenly,  but  seldom  after  the  age  of  four  years.  According 
to  Gov/ers,  of  all  cases  under  ten  years,  three-fifths  occur  in 
the  first  two  years  of  life  ;  and  he  claims  that  a  considerable 
number  of  cases  are  congenital.  There  is  usually  a  febrile  ini- 
tial stage  followed  by  the  sudden  onset  of  paralysis  in  one  leg 
or  arm.  In  more  than  half  the  cases  the  lower  limbs  are 
affected;  of  the  remainder,  the  majority  represent  implications 
of  the  arms,  notably  the  deltoid  muscles,  and  legs,  or,  perhaps, 
arm  and  leg,  and  very  seldom  the  upper  extremity  alone. 
The  cause  of  infantile  paralysis  is  generally  assigned  to  teeth- 


DIAGNOSIS   OF  MOUTH   AFFECTIONS.  75 

ing,  cold  or  damp,  injuries  to  the  spine,  measles,  scarlatina, 
malarial  or  other  fevers,  convulsions  or  concussion.  Dr.  Rot, 
at  the  Fourth  Prussian  Congress,  declared  that  heredity  is  the 
only  etiological  factor  that  has  been  proven.  "  The  primary 
cause  of  the  affection  must  be  sought  for  in  the  modifications 
of  that  part  of  the  fecundated  ovum  which  enters  into  the 
formation  of  the  nervous  system."  During  the  period  of  denti- 
tion, children  are  liable  to  disorders  of  the  cerebro-spinal  sys- 
tem, and  as  from  such  causes  we  find  convulsions  the  cause  of 
the  death  of  numberless  infants  seemingly  robust,  so  we  see 
the  same  cause  producing  paralysis.  There  is  loss  of  heat 
and  atrophy  in  the  affected  limbs,  and  the  latter  may  be  a 
feature  of  the  disease  dependent  upon  the  morbid  changes  in 
the  nerve-centres.  The  atrophy  extends  to  the  bony  system, 
the  nutrition  of  which  is  involved ;  and  it  is  evident  that  the 
atrophic  degeneration,  if  not  inherent,  is  a  real  sequence  of  in- 
flammatory process  in  the  spinal  cord. 

Treatment. — The  treatment  of  infantile  paralysis  consists  in 
the  application  of  mild  galvanic  stimulation  by  the  uninter- 
rupted current  conveyed  through  the  affected  cord  out  dirough 
the  nerves  of  the  flabby  muscles;  the  skin  may  also  be  stimu- 
lated with  salt  and  sulphur  baths.  In  the  early  stage  Dr. 
Althaus  advises  the  injection  of  ergotine  ^  gr.,  for  a  child  a 
year  old,  in  order  to  contract  the  arterioles  of  the  part  to  de- 
plete the  blood  supply.  He  stimulates  the  muscles  as  they 
become  affected  with  injections  of  strychnine.  Conium  and 
chloral  may  be  used  to  calm  nervous  excitement.  Dr.  Sequin 
recommends  counter-irritation  over  the  spine,  bromides  and 
arsenic,  while  others  use  cupping,  leeches,  and  iodide  of  po- 
tassium. Brown-Sequard  recommended  belladonna  to  control 
the  inflammatory  process  of  the  spinal  cord.  If  pain  or  fever 
are  present,  ether  spray  to  the  spine,  ice,  gelsemium,  aconite, 
antipyrine  internally.*  Rubbing,  muscle-beating  and  massage, 
have  also  been  employed  as  adjuncts. 

Chemical  Bleaching  of  Teeth. — Prof  Truman's  method  con- 
sists in  liberating  chlorine  from  calcium,  hydrochlorite,  or  chlo- 
ride of  lime,  in  the  cavity  of  decay  and  pulp  canal  by  a  dilute 


76  DENTAL  MEDICINE. 


acid.  He  recommends  a  fifty  per  cent,  solution  of  acetic  acid, 
although  oxalic,  citric  or  tartaric  acid  may  be  used,  or  indeed 
any  dilute  acid  to  liberate  the  chlorine.  The  upper  third  of 
the  pulp  canal  should  be  filled  with  gutta-percha,  and  the 
cavity  in  all  cases  should  be  washed  out  with  ammonia  or 
borax,  to  remove  the  fatty  matter  previous  to  the  introduction 
of  the  bleaching  agent.  Labarraque's  solution  of  soda  has  also 
been  used  as  a  medium  from  which  to  liberate  the  chlorine. 
Dr.  A.  W.  Harlan  uses  aluminum  chloride  in  the  cavity,  from 
which  he  liberates  the  chlorine  by  means  of  peroxide  of  hy- 
drogen. Dr.  Edw.  C.  Kirk's  method  consists  of  liberating 
sulphurous  acid,  SOg,  from  sodium  sulphite,  Na2S03,  by  means 
of  boracic  acid.  The  two  substances,  in  the  proportion  of 
lOO  grains  of  sodium  sulphite  and  70  grains  of  boracic  acid, 
are  desiccated  separately,  and  then  intimately  ground  together 
in  a  warm  dry  mortar.  In  using  this  powder,  the  tooth  is 
carefully  dried  under  the  dam,  and  the  powder  is  packed  into 
the  pulp-cavity  and  cavity  until  both  are  full ;  the  reaction  which 
liberates  the  sulphurous  acid  is  then  brought  about  by  moist- 
ening the  powder  in  the  tooth  with  a  drop  of  water,  and  the  ori- 
fice of  the  cavity  is  immediately  closed  with  warm  gutta-percha; 
also  peroxide  of  sodium  50  per  cent,  solution  followed  by  ap- 
plication of  a  dilute  acid,  such  as  sulphuric  hydrochlorine,  or 
trichloracetic,  all  applied  on  asbestos  fibre ;  also  pyrozone,  5 
per  cent,  and  25  per  cent,  solutions  ;  also  decomposing  chloride 
of  magnesia  or  chloride  of  tin  with  peroxide  of  hydrogen 
within  the  tooth. 

Herpes  Zoster  of  Mouth  and  Gums. — An  acute  circumscribed 
inflammatory  affection,  characterized  by  an  eruption  of  vesicles 
of  herpes  on  a  red,  inflamed  basis,  the  vesicles  being  disposed 
in  groups  and  follow  the  group  of  the  adjacent  nerve.  The 
eruption  is  preceded  and  accompanied  by  a  very  severe  neu- 
ralgia of  the  fifth  nerve.  The  period  of  invasion  (three  days) 
is  accompanied  by  a  well-defined  fever  and  other  general 
symptoms.  The  period  of  eruption  begins  on  the  third  day, 
and  lasts  about  three  weeks  to  one  month,  the  pain  being  per- 
sistent.    It   is   probably  of  an   infectious   origin,  and  is   due 


DIAGNOSIS   OF   MOUTH   AFFECTIONS.  77 

to  a  neuritis  of  the  affected  region  which  leads  to  tropic 
changes. 

Treatment. — Dr.  Harlan  recommends  a  palliative  treatment, 
which  consists  of  placing  cotton-wool  between  the  cheek  and 
teeth  to  prevent  friction,  and  on  it  an  ointment  consisting  of 
cocaine  and  morphine. 

Merck's  Bulletin  gives  the  following  new  treatment  for 
herpes  zoster : 

MIXTURE. 

R.     Extract  gelsemium  ")     ^       ,    , 

^       o  J-  1  u         lit    y  of  each  4  grammes. 

Sodmm  sulpho-carbolate  J  ^  ° 

Distilled  water 90  grammes. 

M:  Sig:     One  teaspoonful  every  two  hours. 

At  the  same  time  five  drops  tincture  of  belladonna  are  ad- 
ministered every  two  hours  until  a  slight  dryness  of  the 
pharynx  is  experienced. 

LOTION. 

R;     Lead  acetate,      i     .       , 

^      ,       ,    ,         y  of  each  4  grammes. 
Powdered  alum,  J 

Distilled  water 120  grammes 

M;  Sig.    Externally. 

Compresses  moistened  with  this  solution  are  applied  to  the 
affected  parts,  and  renewed  every  two  hours.  It  is  claimed 
that  the  pain  disappears  within  a  few  hours,  and  that  the  dis- 
ease is  considerably  shortened  by  this  treatment. 

Dental  Caries  is  indicated  by  a  process  of  gradual  softening 
and  disintegration  of  the  tooth  tissues  by  deleterious  agents, 
the  progress  being  hastened,  primarily,  by  certain  structural 
defects  in  the  enamel  and  dentine,  and  secondarily,  by  certain 
diseases  of  the  mucous  membrane,  and  some  derangement  of 
the  general  health.  Incipient  dental  caries  is  indicated  by  an 
opaque,  whitish  or  gray  appearance  of  the  enamel.  A  pale 
brown  varying  to  a  nearly  black  color  indicates  the  existence 
and  progress  of  dental  caries  in  the  tooth  tissues ;  the  deeper 
the  color  the  slower  the  progress  of  the  caries,  and  the  paler 
the  color  the  more  rapid  the  progress.     The  softening  and  de- 


78  DENTAL  MEDICINE. 


calcifying  of  the  bones,  and  the  proneness  of  the  teeth  to 
caries  during  pregnancy,  is  ascribed  to  faulty  nutrition  and  the 
lack  of  the  supply  of  the  proper  elements  to  the  system,  and 
the  waste  going  on  during  this  period.  But  the  principal  ex- 
citing cause  of  caries  of  the  teeth  during  pregnancy  is  the 
lactic  acid  fermentation  present,  its  action  being  greatly  aug- 
mented by  the  changed  condition  of  the  fluids  of  the  mouth, 
such  acids  existing  in  the  secretions  of  the  mouth  as  hydro- 
chloric, acetic,  oxalic  and  uric. 

Treatment. — Incipient  caries  should  be  removed  with  great 
care,  and  the  exposed  surface  of  tooth  structure  prepared  to 
resist  further  attacks  by  giving  to  it  as  high  a  polish  as  is  pos- 
sible, and  the  patient  warned  in  regard  to  its  future  cleanli- 
ness. Deep-seated  caries  should  be  removed,  and  its  further 
progress  arrested  by  thoroughly  sterilizing  or  disinfecting  the 
cavity  by  antiseptics  and  disinfectants,  and  the  careful  insertion 
of  fillings  of  a  durable  material.  During  pregnancy  all  oper- 
ations on  the  teeth  should  be  painless,  and  long,  wearying  sit- 
tings be  avoided.  Caries  of  the  teeth  of  pregnant  women  can 
be  arrested  by  plastic  fillings  until  such  time  as  the  patient 
can  the  better  endure  more  permanent  operations.  The  pre- 
ventive measures  consist  in  the  thorough  and  frequent  use  of 
the  tooth-brush  and  its  adjunct,  floss  silk,  at  least  three  times 
a  day,  assisted  by  a  proper  dentifrice  and  antacid  mouth-wash. 

CHARACTERISTIC   INDICATIONS   OF   THE   TONGUE. 

The  tongue,  when  in  a  normal  condition,  should  be  freely 
movable,  of  a  pink  color,  and  the  dorsum  marked  in  the  centre 
by  a  slight  longitudinal  depression :  a  velvety  appearance, 
soft,  moist  and  warm  to  the  finger;  the  fungiform  papillae  cir- 
cular in  outline,  and  deeper  pink  than  the  surrounding  sur- 
face; the  circumvallate  papillae,  arranged  in  a  V-shaped  row, 
having  the  form  of  an  inverted  cone,  surrounded  by  an  annu- 
lar elevation.  Fever  causes  the  tongue  to  be  frosted  or 
coated ;  gastro-intestinal  affections  are  attended  by  coating  of 
the  tongue,  and  the  various  appearances  of  this  coating  are  of 
important   diagnostic   and   therapeutic  significance.     Inflam- 


INDICATIONS   OF   THE   TONGUE.  79 

mation  reddens  the  mucous  membrane  and  makes  it  hot  and 
tender,  increases  its  moisture,  changes  the  surface  of  the 
tongue,  and  causes  the  formation  of  aphthae,  ulceration,  and 
even  gangrene.  In  aphthous  stomatitis  the  edges  of  the 
tongue  are  clean  and  red,  while  its  dorsum  is  covered  with  a 
thick  white  coating.  In  ulcerative  stomatitis  the  tongue, 
besides  presenting  the  marginal  ulcers,  is  swollen  and  heavily 
coated  with  a  dirty,  yellowish  white  fur.  In  thrush  the 
mucous  membrane  is  covered  with  white,  curd-like  flakes,  due 
to  the  development  of  the  parasite  oidiwn  albicans.  Prior  to 
the  appearance  of  the  flakes  the  mucous  membrane  is  pur- 
plish-red and  sticky,  and  its  secretion  acid  in  reaction.  In 
severe  neuralgia  of  one  side  of  the  face,  the  tongue  presents 
an  unilateral  furring,  thickening  of  the  mucous  membrane,  or 
enlargement  of  the  papillae.  Acute  or  chronic  alcoholism 
causes  a  tremulous  and  foul  tongue.  Migraine  causes  a  much 
furred  surface  of  the  tongue.  When  paralyzed,  the  tongue 
presents  the  appearance  of  a  sodden  mass  lying  in  the  mouth ; 
in  chorea  its  movements  are  jerking  and  irregular ;  in  cerebral 
disease,  the  tongue  shows  a  tendency  to  become  thickly  furred, 
and  very  foul,  especially  in  apoplexy  due  to  hemorrhage. 
Allowance,  however,  must  always  be  made  for  individual 
peculiarities  in  shape  and  size  of  the  tongue,  as  also  appear- 
ance, for  effects  of  certain  habits,  such  as  excessive  smoking 
or  chewing  tobacco,  etc.,  taking  iron,  or  other  medicines,  or 
for  any  local  irritation.  In  some  individuals  the  surface  of 
the  tongue  presents  constantly  a  thick  fur  without  disturbance 
of  organs  or  appetite,  while  on  the  other  hand,  a  perfectly 
clean  and  healthy-looking  tongue  may  be  associated  with 
severe  dyspeptic  symptoms  or  serious  alimentary  trouble. 
The  common  appearances  of  the  tongue  are  supposed  to  indi- 
cate the  following  conditions : 

A  White  Coated  Tongue  indicates  febrile  disturbarice. 

A  Brown  Moist  Tongue  indicates  digestive  disorder  gind  an 
overloaded  stomach. 

A  Brown  Dry  Tongue  indicates  depressed  vital  power. 

A  Red  Moist  Tongue  indicates  feebleness,  especially  from 
exhaustive  discharges. 


80  DENTAL   MEDICINE. 


A  Red  Dry  Tongue  indicates  inflammatory  fever  or  pyrexia. 

A  Red  Glazed  Tongue  indicates  debility  and  inability  to 
digest  food  and  stimulants. 

A  Tremulous,  Moist  and  Flabby  Tongue  indicates  feeble- 
ness and  nervousness. 

A  Glazed  Bluish  Tongue,  with  loss  of  epithelium  in  patches, 
and  in  severe  cases,  cracks  and  scars,  indicates  tertiary  syphilis. 

TABLES  FOR  PREPARING  PERCENTAGE  SOLUTIONS. 

The  following  tables  of  Dr.  Sherrard,  Ph.  C.,  are  simple  and 
require  but  little  explanation.  The  first  table  gives  percentage 
solutions,  as,  for  instance,  4  per  cent,  cocaine  muriate  solu- 
tion; the  second  table  gives  parts  in  1,000  or  5,000,  as,  for 
instance,  corrosive  sublimate  i  in  1,000.  The  use  of  the  first 
table  is  as  follows :  Run  down  column  i  until  the  correct 
percentage  wanted  is  found,  then  move  to  the  right  along  the 
line  until  the  column  is  found  giving  the  amount  of  the  fluid 
measure  to  be  made  up ;  at  the  intersection  will  be  found  the 
weight  of  the  salt  required.  For  example,  suppose  it  is 
desired  to  make  4  fl.  oz.  of  4  per  cent,  cocaine  muriate  solu- 
tion, run  down  the  left-hand  column  to  4,  then  along  to  the 
right  till  the  column  headed  4  fl.  oz.  is  reached.  At  the  inter- 
section of  the  two  will  be  found  72  912,  and  this  is  the  number 
of  grains  needed.  It  must  be  remembered  that  this  is  the 
amount  of  zvater  to  take,  and  not  q.  s.  water  to  make  the  vol- 
ume, and  also  that  these  tables  are  true  only  for  water,  and 
not  for  alcohol,  or  any  other  fluid.  The  second  table  is  sim- 
ilarly employed.  If  other  amounts  of  a  solution  are  required 
than  those  given  in  the  tables,  a  simple  mathematical  calcula- 
tion will  determine  the  amount  of  drug  or  salt  required  for  a 
specified  amount  of  solution.  For  example,  if  8  fluid  ounces 
of  a  four  per  cent,  solution  is  required,  follow  down  the  4 
fluid  ounce  column  until  opposite  4  per  cent. ;  the  number  of 
grains  required  are  72,912.  Now,  to  make  8  fluid  ounces, 
just  twice  as  much  (145,824  grs.)  is  required.  For  all  dis- 
pensing and  administering  purposes  in  any  prescribed  doses, 
the  figures  thus  given  are  correct.     It  is  therefore  clear  that 


TABLES   FOR  PERCENTAGE   SOLUTIONS. 


81 


if  a  drachm  of  a  2  per  cent,  solution  be  prescribed,  exactly  2 
per  cent,  of  that  drachm  is  the  salt  in  the  solution,  the  other 
98  per  cent,  being  the  water. 


FOR    MAKING    ANY   QUANTITY   OF    PERCENTAGE   SOLUTIONS. 


1 

^,"    lU 

_•  <u 

,/  ^ 

.  •    (U          1      ..   1)          1       •   1)          1        •   0]                1 

0-3  ^ 

^■a 

N'Q 

N   J= 

N-a                   ^^                    S^ 

0  ■"    . 

0  ^        . 

0    ■" 

0    ""                   0    ""        .            0    ■" 

=='S1 

^°1 

"^'  Si 

'^^lli^l   "^'Si    1 

^  5  0 

^50 

-50  \_^3  0 

r^isl^ife 

"Is 

r  eac 
watei 
drug 

r  eac 

water 

drug 

r  eac 
watei 
drug 

r  eac 
water 
drug 

r  eac 
water 
drug 

r  eacl 
water 
drug 

r  eacl 
water 
drug 

tS'B 

^'o 

1^  0 

'^^ 

0  i^ 

0^ 

t=H     0 

^^ 

To  make 

Grains.     Grains. 

Grains,  i  Grains.  |  Grains. 

Grains. 

Grains. 

I  per  cent.  . 

4.557       9-II4 

13.671;    18.228I    22.785 

45-57 

72.912 

2  per  cent.  . 

9.114     18.228 

27.342    36.456    45-57°:      91-14I   145-^24 

i     3  per  cent,  . 

13-6711    27.352 

41.0131    54.684:    68.355     136-711    218.416 

i     4  per  cent.  . 

18.228    36.456 

54.6841    72.912'    91.14  '    182.28    291.648 

5  per  cent.  . 

22.785    45-57 

68.355     91.14     113-925     227.85    364.56 

ID  per  cent.  . 

45-57  i    91-14 

136.71      182.28     227.85       455.7       729.12 

15  per  cent.  . 

68.355  136.71 

205.065  273.42     341.775     683.55  1093.68 

20  per  cent.  . 

9I-H 

182.28 

273.42    364.56  1455-70  '    9II-4  ;i45S.24 

25  per  cent.  . 

H3-925 

227.85 

341.775,455-70    569-625  1139.25  1822.80 

40  per  cent.  . 

182.28 

364.56  1 

546.84  [729.12    911. 4      1822.8    2916.48 

FOR   MAKING   ANY   QUANTITY   OF   SOLUTION    WHEN    STATED    IN    PARTS    PER 
THOUSAND,    HUNDRED,    ETC. 


-J  "" 

.,;  ^ 

•    (U            1     ._.    4J            1        •    1) 

0  — 

0  ^    . 

0^        • 

°t^      =£    . 

§i= 

0    ^           . 

^^1 

^•i:1 

-•^1 

^"  2  "i  i  «■  S 1 

«=-^« 

^      Z^ 

r  each   1 

water  tak 

drug  or 

r  each  2 
water  tak 
drug  or 

r  each  3 

water  tak 

drug  or 

r  each  4 

water  tak 

drug  or 

r  each  5 
water  tak 
drug  or 

r  each  10 

water  tak 

drug  or 

r  each  16 
water  tak 
drug  or 

^"Z 

h   0 

^•Z 

,0  I-          0  <— 

til      0                  1     H^l      0 

,^    0 

cS'B 

To  make  a  so 
lution  of 

Grains. 

Grains. 

Grains. 

Grains.    Grains. 

Grains. 

Grains^ 

I  in  1000  .    . 

-4557;       -9' 14 

I.3671 

1.8228 

2.278 

4.557 

7.291 

I  in  500 

.9114     1.8228 

2.7312     3.6456 

4.557 

9. 1 14 

14.582 

I  m  400 

1.139       2.278 

3.4177 

4.5  7 

5.695 

11.392 

18.228 

I  in  300 

1.519       3-035 

4.557 

6.076 

7.59 

15.19 

24.304 

I  in  200 

2.2785     4.557 

6-8355 

9.114 

11.39       22.785 

36.456 

I  in  100 

4.557       9-114 

13.671 

18.228 

22.785     45-57 

72.912 

I  in  50 . 

9. 114     18.228 

27-342     36.456 

45-57  1    9i-'4 

145.824 

I  in  25  . 

18.228  1  36.456 

54-684  j  72.912  1    91.14  I  1S2.28 

291.648 

I  in  10 . 

45.570     91.140   136.710   182.280    227.85  1  455.70 

729.120 

I  in  5  .     .    . 

91.14     182.28     273.42     364.56      455.7     I  91 1.4 

1458.24 

82 


DENTAL   MEDICINE. 


ABBREVIATIONS. 


In  medical  prescriptions,  letters,  parts  of  words,  or  certain 
symbols,  are  employed  as  abbreviations,  to  designate  the  sub- 
stance, quantity,  etc.,  as  follows  : — 


ABBREVIATION. 

LATIN   WORD. 

ENGLISH   WORD. 

aa. 

Ana  (G.), 

Of  each. 

Ad  Saturand., 

Ad  saturandum. 

Until  saturated. 

Ad  lib., 

Ad  libitum, 

At  pleasure. 

Aq., 

Aqua, 

Water.                        , 

Aq.  tepid., 

Aqua  tepida, 

Warm  water. 

Aq.  ferv., 

Aqua  fervens, 

Hot  water. 

Aq.  dest., 

Aqua  destillata. 

Distilled  water. 

C.  or  Cong. , 

Congius, 

A  gallon. 

Chart., 

Chartula, 

A  small  paper. 

Coch., 

Cochlear, 

A  spoonful. 

Coch.  mag., 

Cochlear  magnum, 

A  tablespoonful. 

Coch.  parv.. 

Cochlear  parvum, 

A  teaspoonful. 

Colent., 

Colentur, 

Let  them  be  strained. 

Collyr. , 

CoUyrium, 

An  eye-water. 

Comp. , 

Compositus, 

Compound. 

Contus., 

Contusus, 

Bruised  or  broken. 

Cort., 

Cortex, 

Bark. 

Ext., 

Extractum, 

An  extract. 

F.  or  Ft. , 

Fiat  vel  fiant, 

Let  there  be  made. 

Fol., 

Folium  vel  folia, 

A  leaf  or  leaves. 

Garg., 

Gargarysma, 

A  gargle. 

Or., 

Granum  vel  grana, 

A  grain  or  grains. 

Gtt., 

Gutta  vel  guttse, 

A  drop  or  drops. 

Haust., 

Haustus, 

A  draught. 

Infus., 

Infusum, 

An  infusion. 

M., 

Misce, 

Mix. 

Mass., 

Massa, 

A  mass. 

Mist., 

Mistura, 

A  mixture. 

0., 

Octarius, 

A  pint. 

Pil., 

Pilula  vel  pilule, 

A  pill  or  pills. 

Pulv., 

Pulvis  vel  pulveres. 

A  powder  or  powders. 

q.  s.. 

Quantum  sufficit, 

A  sufficient  quantity. 

R., 

Recipe, 

Take. 

Rad., 

Radix, 

A  root. 

■S., 

Signa, 

Write  or  give  directions, 

Spts., 

Spiritus, 

Spirits. 

ss.. 

Semis, 

The  half. 

Syr., 

Syrupus, 

Syrup. 

Tinct., 

Tinctura, 

A  tincture. 

R)., 

Libra, 

A  pound. 

I, 

Uncia, 

An  ounce. 

.3. 

Drachma, 

A  drachm. 

Scrupulus, 

A  scruple. 

f  ? 

Fluiduncia, 

A  fluid  ounce. 

iZ, 

Fluidrachma, 

A  fluid  drachm. 

m. 

Minim, 

A  drop. 

ABBREVIATIONS   FOR   PRESCRIPTIONS.  83 

Although  the  symbol  (1U)  is  adopted  in  the  United  States 
Pharmacopoeia  to  designate  a  drop,  it  should  be  remembered 
that  the  size  of  a  drop  varies  according  to  the  greater  or  less 
fluidity  and  gravity  of  the  liquid,  and  the  shape  of  the  mouth 
of  the  bottle  from  which  it  is  dropped.  It  is  best  to  use  a 
glass  medicine-dropper,  or  a  small  vial  with  a  thin  edge  of 
mouth,  when  great  precision  is  necessary,  and  to  dilute  the 
active  medicine  and  administer  it  in  the  form  of  a  mixture ; 
for  in  some  preparations,  one  hundred  and  fifty  drops  would 
measure  but  a  fluidrachm,  while  in  others  the  same  number 
of  drops  would  be  somewhat  more  than  three  fluidrachms. 

But  there  is  a  wide  difference  between  a  drop  and  a  minim, 
and  although  a  drop  is  usually  considered  as  one-sixtieth  part 
of  a  fluidrachm,  this  is  only  true  of  water  and  some  other 
liquids,  and  drops  of  the  same  liquid  vary  under  different  cir- 
cumstances. Specific  gravity,  viscidity  or  adhesiveness,  and 
mobility  modify  the  size  of  drops.  The  heavier  the  liquid  the 
smaller  will  be  the  drops,  and  the  greater  number  in  a  given 
measure. 

The  drops  from  a  thick-lipped  bottle  are  larger  than  those 
from  one  having  thin  lips ;  and  drops  from  a  full  bottle  are 
generally  smaller  than  those  from  a  bottle  partially  filled,  on 
account  of  rapidity  of  movement.  The  adhesiveness  of  a 
liquid  to  the  sides  of  a  bottle  increases  the  size  of  the  drops, 
as  a  greater  mass  is  necessary  to  overcome  the  viscidity. 
Drops  are  also  increased  in  size  by  the  greater  mobility  of  a 
liquid. 

A  tablespoonfnl  of  any  liquid  is  regarded  as  equal  to  Jialf 
an  ounce  by  measure ;  and  a  teaspoonful  equal  to  d^fLiddrachm  ; 
and  such  measures  are  sufficiently  accurate  where  no  great 
precision  is  requisite. 

A  gallon  contains  eight  pints. 

A  pint  contains  sixteen  fluid  ounces. 

A  fluid  ounce  contains  eight  fluidrachms, 

A  fluidrachm  contains  sixty  minims  (ITL). 

A  wine  glass  (approximate  measurement)  contains  two  fluid 
ounces. 


84  DENTAL  MEDICINE. 


A  teacup  (approximate  measurement)  contains  four  fluid- 
ounces. 

A  tablespoon  of  powder  (approximate  measurement)  con- 
tains two  drachms. 

A  teaspoon  of  powder  (approximate  measurement)  contains 
one-half  drachm. 

One  drop  of  water  (small  drop,  approximate  measurement) 
contains  one  minim. 

One  drop  of  essential  oils  (approximate  measurement)  con- 
tains one-half  minim. 

A  graduated  measure  glass  is  the  most  accurate  measure, 
as  spoons,  glasses,  etc.,  vary  greatly  in  size. 

MEASURING    LIQUIDS    BY    DROPS. 

In  measuring  liquids  by  drops,  a  glass  medicine-dropper 
should  be  used,  as  the  uncertainty  of  dropping  from  various 
shaped  bottles  should  not  be  depended  upon. 

The  following  list  shows  the  relative  difference  between 
drops  and  minims  of  a  few  of  the  drugs  used  in  dental  prac- 
tice. 

Number  of  Drops  in  Sixty  Minims — 


Carbolic  Acid in 

Sulphuric  Acid 128 

Sulphuric  Acid  (dilute) 60 

Aromatic  Sulphuric  Acid    .    .    .    .146 

Ether 172 

Alcohol 146 

Alcohol  (dilute) 137 

Aqua  Destillatse 60 

Aqua  Ammonia 64 

Chloroform  (purified) 250 

Creasote 122 

Fl.  Extract  of  Ergot 133 

Glycerine 67 

Liq.  Chloride  of  Zinc 89 

Oil  Cajeput I34 


Oil  Cloves 130 

Oil  Cinnamon 126 

Oil  Wintergreen 125 

Oil  Peppermint 129 

Oil  Sassafras 133 

Oil  Turpentine 136 

Aromatic  Spts.  Ammonia    .    .    .    .142 

Spts.  Camphor 143 

Syrups 65 

Tinct.  Aconite 146 

Tinct.  Benzoin  (Comp.) 148 

Tinct.  Digitalis •  .  128 

Tinct.  Chloride  of  Iron 150 

Tinct.  Opii 130 

Vinum  Opii 100 


FINENESS    OF    POWDER. 


The  fineness  of  powder  is   denoted  either  by  descriptive 
words  (as  in  the  case  of  brittle  and  easily  pulverizable  sub- 


WEIGHTS   AND   MEASURES.  S5 

Stances),  or  in  terms  expressing  the  number  of  meshes  to  a 
linear  inch  in  the  sieve.  The  following  degrees  of  fineness 
will  prove  serviceable  in  the  preparation  of  dentifrices,  polish- 
ing powders,  etc. : — 

("Should  pass  through  a"> 

A  very  fine  powder  .     .     .  \  ^'^ve  having  so  or  more  ^= No.  80  Powder. 

'^  (   meshes  to  linear  inch.   J 

("Should  pass   through  a") 

A.  fine  powder     .     .     .     .\  ^'^ve  having  60  meshes  ^-— No.  60  Powder. 

(^       to  the  linear  inch.       J 

("Should  pass  through  a")  t->  i 

A  rnodej'-ately  fine  powder  \  s'^^e  having  50  meshes  ^=No.  ^o  Powder. 

•'  -^  (       to  the  linear  inch.       J  -^ 

("Should  pass  through  a~l 

Kmoderately  coarse  powder-^  sieve  having  40  meshes  V=:;No.  40  Powder. 

(to  the  linear  inch.       j 

("Should  pass  through  a~)  -r-i  i 

A  coarse  powder      .     .     .  s  sieve  having  20  meshes  v^No.  20  Powder. 

(^       to  the  linear  inch.       J 

WEIGHTS  AND  MEASURES. 
APOTHECARIES'  WEIGHT. 

20  grains  (gr.)  make  i  scruple sc.  or    ^ 

3  scruples        make  i  drachm dr.  or   5 

8  drachms       make  i  ounce oz.  or   5 

12  ounces  make  i  pound lb.   or  ft 

SCALE   OF   COMPARISON, 

ft)                             oz.                           ■   dr.  sc.                              gr. 

I             ^              12             =              96             ^  2S8  =           5760 

I             ^                8             ^  24  ^             480 

I             =  3  =               60 

I  =  20 

TROY  WEIGHT. 

24  grains  (gr.)      make  i  pennyweight dwt. 

20  pennyweights  make  I  ounce oz. 

12  ounces  make  i  pound K). 

ZYz  grains  make  i  carat  (diamond  weight) k. 

SCALE   OF    COilPARISON. 

lb,  oz.  dwt.  gr. 

I  ^  12  =^  240  =  5760 

I  =^  20  =  480 

I  =  24 

Ik.  =.  1% 

AVOIRDUPOIS   WEIGHT. 

16  drachms  (dr.)    make  i  ounce oz. 

16  ounces  make  I  pound ft). 

25  pounds  make  i  quarter qr. 

4  quarters  make  i  hundredweight cwt. 

20  hundredweight  make  i  ton T. 

100  pounds  make  i  central C. 


86  DENTAL  MEDICINE. 


SCALE  OF 

COMPARISON, 

T. 

cwt. 

qr. 

ft). 

oz. 

dr. 

I 

= 

20 

=    80    = 

2000 

= 

32000 

= 

512000 

I 

=     4    = 

100 

= 

4000 

= 

25600 

I    = 

25 

^ 

400 

= 

6400 

I 

= 

16 

I 

= 

.  256 
16 

THE     METRIC    OR    FRENCH     DECIMAL     SYSTEM    OF   WEIGHTS     AND 

MEASURES. 

The  metric  system  is  based  upon  the  meter,  which  is  the 
standard  unit  of  length  of  that  system,  and  equal  to  39.370432 
inches,  or  about  10  per  cent,  longer  than  the  yard. 

The  metric  unit  oi  fluid  measure  is  the  liter — the  cube  of 
tV  meter,  or  looo  cubic-centimeters — equal  to  about  34  fluid 
ounces. 

The  metric  unit  of  zveight  is  the  gram,  which  represents  the 
weight  of  one  cubic-centimeter  of  water  as  its  maximum 
density.     It  is  equal  to  I5(.43234874)  troy  grains. 

One  CUBIC-CENTIMETER  is  equal  to  16,231  minims. 

In  writing  prescriptions  it  is  sufficiently  ACCURATE 
AND  SAFE  TO  CONSIDER  I  GRAM  AS  EXACTLY  EQUAL  TO  1 5  TROY 
grains,  AND  TO  CONSIDER  I  CUBIC  CENTIMETER  AS  EQUAL  TO  1 5 
MINIMS. 

We  accordingly  have — 

I  gram  equal  -¥-  troy  grains. 

I  troy  grain  equal  to  tV  gram. 

I  cubic  centimeter  equal  to  \  fluidrachm. 

I  fluidrachm  equal  to  t  cubic  centimeter. 
Hence — 

1.  To  CONVERT  TROY  GRAINS  INTO  GRAMS,  OR  MINIMS  INTO 
CUBIC  CENTIMETERS 

a.  Divide  by  lo,  and  from  the  quotient  siLbtract  one-tliird ; 
or,  b.  Divide  by  75;  and 

2.  To  CONVERT  apothecaries'  DRACHMS  INTO  GRAMS,  OR 
FLUIDRACHMS  INTO  CUBIC  CENTIMETERS,  multiply  by  ^. 

In  writing  prescriptions,  the  "  gram  "  (abbreviated  "  Gm.") 
and  "  cubic  centimeter"  (abbreviated  "  C.C.,"  which  maybe 
called  "fluigram,"  and  written  "  fGm  ")  only,  should  be  used. 


WEIGHTS   AND  MEASURES.  87 

The  centigram,  which  is  a  very  convenient  unit  to  refer  to 
in  medicine  and  pharmacy,  is  used  in  books  and  in  speaking, 
but  not  in  writing  prescriptions. 

All  other  terms,  and  units,  and  prefixes,  used  in  the  metric 
system,  may  be  wholly  ignored  by  the  physician  and  the 
pharmacist.* 

EXAMPLE  OF  A    METRIC   PRESCRIPTION, 


R.     Hydrarg.  chloridi.  corros o 

Potassi  iodidi lo 

Aqu?e ICO 

Tinct.  cinch,  comp ;  loo 

Mix. 


25  Gm. 
00  Gra. 
00  C.C. 
00  C.C. 


The  use  of  a  decimal  line  prevents  possible  errors. 

To  write  a  prescription  for  fifteen  doses  of  any  medicine, 
write  it  first  for  one  dose  in  grains  and  minims,  and  then 
substitute  the  same  number  of  "  grams  "  and  "  cube-cents," 
thus  : — 

R.    Opii gr.  j 

Camphorse gr.  ij 

Make  one  pill. 

and  to  get  fifteen  such  doses  in  metric  terms,  write — 

K .     Opii I  Gm. 

Camphorae      2  Gm. 

Make  fifteen  pills. 

The  gram  and  the  cubic  centimeter  [fliugram),  when  refer- 
ring to  liquids,  may  be  considered  as  equal  quantities,  except 
the  liquids  be  very  heavy  (as  in  the  case  of  chloroform),  or 
very  light  (as  in  the  case  of  ether). 

Measures  may  be  discarded  and  weights  exclusively  em- 

*  The  prefixes  are  simply  numerals,  as  follows  : — 


deci,  which  means  o.i 
ce7tti,       "         "      o.oi. 


myriaj  which  means  10,000. 

kilo,  "  "  1,000. 

hecto,         "         "  100.  j  milli,       "  "      o.ooi. 

deka,  "  "  10. 


and  are  quite   unnecessary  in  the  writing  of  prescriptions    (if  not  in  all  cases), 
English  numerals  being  more  convenient,  and  at  least  equally  explicit. 


88 


DENTAL  MEDICINE. 


ployed,  if  preferred.  All  quantities  in  a  prescription  would 
then  be  expressed  in  grams.* 

The  average  "  drop  "  (water)  may  be  considered  equal  to 
0.05  C.C.,  or  0.05  Gjh.  An  average  teaspoon  holds  5  C.C, 
and  an  average  tablespoon  20  C.C.  Decimal  numbers 
should  be  used  as  far  as  practicable  without  sacrifice  of  ac- 
curacy as  to  strength  and  dose  of  the  preparation.  It  is  safe 
to  prescribe  30  Gin.  for  one  troy  ounce,  and  250  C.C.  for  eight 
fluid  ounces. 

The  above  contains  all  that  is  necessary  to  know  or 
LEARN  of  the  metric  system,  in  order  to  write  metric  pre- 
scriptions, without  a  metric  posological  table,  or  with  one. 

To  become  familiar  with  the  system,  the  rules  given  above 
for  the  conversion  of  apothecaries'  weights  and  measures  into 
the  corresponding  metric  quantities,  may  be  profitably  used, 
the  results  to  be  verified  by  comparison  with  the  following — 

table  of    EQUIVALENTS. 


apothecaries' 

METRIC 

apothecaries' 

metric 

WEIGHTS 

WEIGHTS 

WEIGHTS 

WEIGHTS 

(and  measures). 

(and  measures). 

(and  measures). 

(and  measures). 

Troy  grains 

Grams 

or  cubic- 

Drachms 

Grams 

{or  minims). 

centimeters). 

{or  fliiidrachms') . 

{or  ct 

bic-cejitimeters). 

i^ 

O.OOI 

(rffVir) 

I 

4 

-il 

0.002 

(xAiy) 

2 

8 

xV 

0.004 

(tSST!-) 

4 

16 

\ 

0.008 

(to^o) 

6 

24 

\ 

0.016 

{-k) 

Troy  ounces  {or  Jiuidounces) 

* 

0.03  s 

(aV) 

I 

32 

I 

0.066 

(tV) 

2 

64 

2 

0-I33 

(1^5) 

4 

128 

5 

0.333 

(*) 

6 

192 

10 

0.666 

(f) 

8 

256 

15 

1. 000 

(I) 

12 

384 

20 

1-333 

(li) 

16 

512 

30 

2.000 

(2) 

*  As  any  liquid  medicine  must  necessarily  be  administered  to  the  patient  in 
measured,  and  not  in  weighed,  doses,  it  will,  of  course,  be  more  convenient  to  the 
physician  to  continue  to  make  use  of  fluid  measures  in  writing  prescriptions,  es- 
pecially as  he  is  already  accustomed  to  this,  and  would  not  then  have  to  bear  in 
mind  the  specific  gravity  of  any  liquid  ingredient  in  the  prescription.  To  the 
pharmacist  it  makes  but  little  difference,  as  he  will  have  both  weights  and  meas- 
ures, and  can  use  one  or  the  other,  as  may  be  directed.     If  the  physician  discards 


RULES   FOR   REGULATING   DOSES.  89 

The  adoption  of  the  metric  system  of  weights  and  measures 
is  a  matter  of  time  only.  Its  advantages  over  other  systems 
are  well  recognized. 

RULES   FOR   REGULATING   DOSES. 

The  doses  given  in  this  work  are  applicable  to  adult  age 
unless  the  contrary  is  specified;  and  for  the  convenience  of 
students,  the  rules  of  Gaubins  and  Young  for  determining  the 
proper  dose  of  medicines  for  children  are  furnished  below. 

Take  the  dose  for  an  adult  as  unity,  and  for  other  ages  as 
follows : — 

The  dose  foi-  a  person  of  middle  age  being  i,  or  I  drachm, — 

That  for  a  person  from  14  to  21  years  will  be  ^,  or    2  scruples. 

"                       "          7  to  14       "  "  )4,  or  }4  a.  drachm. 

"                      "         4  to    7      "  "  ^,  or    I  scruple. 

"        a  child  of                    4       "  "  ){ ,  or  15  grains. 

"               "                            3       "  "  y^,  or  10  giains. 

"               "                            2       "  "  %,  or    8  grains. 

"               "                           I  year  "  y'j,  or    5  grains. 

The  following  simple  ruleby  Dr.  Young  will  be  found  to  be 

convenient :  "  For  children  under  twelve  years,  the  doses  of 

most  medicines  must  be  diminished  in  the  proportion  of  the 

age  to  the  age  increased  by  12  ;  thus,  at  two  years  to  r  ;  viz  : 

^ ^.     At  twenty-one  the   full    dose  may   be    given." 

2+12     7 

Hence — 


For  one  year, 
For  two  years, 


1  I 

I  +  I2~I3 

2  I 

2+12        7 


For  three  years, =  — 

3+12        5 

For  four  years, =  — 

4+12        4 

TT  •  61 

For  six  years, ^  — • 

6+12        3 


measures,  he  must,  of  necessity,  so  adjust  the  proportion  in  his  formula  as  to  pro- 
duce a  mixture  of  which,  after  all,  the  dose  must  be  a  "  teaspoon ful,"  or  some 
other  convenient  measure,  and  this  is  as  unnecessary  as  it  is  diflicult. —  Oscar 
Oldberg,  Phar.  D.,  in  Blakiston  s  Phys.  Visiting  List. 


90  DENTAL  MEDICINE. 


At  twelve  years  the  dose  is  one-half  that  of  the  adult.  The 
U.  S  Dispensatory  states  that  "  To  the  above  rules  some  excep- 
tions are  offered,  in  particular  medicines,  which  require  to  be 
given  to  children  in  much  larger  proportional  doses  than  those 
above  stated.  Such  are  castor  oil  and  calomel,  a  certain 
quantity  of  which  will,  in  general,  not  produce  a  greater  effect 
in  a  child  two  or  three  years  old  than  double  the  quantity  in 
an  adult."  "  Females  usually  require  smaller  doses  than 
males,  and  persons  of  sanguine  temperament  than  the  phleg- 
matic." The  influence  of  constitutional  peculiarities,  such 
as  are  known  as  idiosyncrasies,  often  exist  and  render  patients 
more  than  usually  susceptible,  or  the  opposite,  to  the  action 
of  medicines,  the  doses  of  which  must  be  regulated  ac- 
cordingly. It  should  also  be  remembered  that  the  suscepti- 
bility to  the  action  of  medicines  is  diminished  by  frequent 
and  continued  use.  In  advancing  age,  the  dose  is  gradually 
lessened. 

Opiates  affect  children  to  a  greater  degree  than  adults,  but 
children  bear  larger  doses  of  calomel  than  adults.  Females 
are  more  rapidly  affected  by  purgatives  than  males,  and  the 
condition  of  the  uterine  system  is  very  important. 

Medicinal  substances  act  differently  on  the  same  person  in 
summer  and  in  winter,  and  in  different  climates.  Narcotics 
act  more  energetically  in  hot  than  in  cold  climates,  and,  as  a 
consequence,  smaller  doses  are  required  in  hot  climates ;  the 
opposite  is  the  case  with  regard  to  calomel.  Owing  to  a  pecu- 
liarity of  stomach,  or  rather  disposition  of  body,  unconnected 
with  temperament,  comparatively  mild  remedies  operate  very 
violently  on  some  individuals. 

When  administering  remedies,  the  intervals  between  the 
doses  should  be  so  regulated  that  the  second  dose  may  be 
taken  before  the  effect  produced  by  the  first  is  entirely  effaced. 
Some  medicinal  substances,  such  as  mercurial  salts,  arsenic, 
etc.,  are  prone  to  accumulate  in  the  system;  and  dangerous 
symptoms  may  arise  if  the  doses  rapidly  succeed  one  another. 

The  action  of  some  remedies,  such  as  digitalis,  elaterium, 
etc.,  may  continue  long  after  the  discontinuance  of  the  agent, 


TOPICAL   REMEDIES.  91 


and  a  too  powerful  effect  occur,  even  by  a  repetition  in  dimin- 
ished doses.  Some  remedies,  such  as  castor  oil,  aloes,  etc., 
acquire  activity  by  continued  use,  hence   the  dose  requires  to 

be  diminished. 

TOPICAL   REMEDIES. 

Medicinal  substances  are  applied  to  the  mucous  membrane 
of  the  mouth  and  to  the  dental  structures  almost  exclusively 
for  local  effects.  In  dental  practice  antiseptic  remedies  are 
extensively  employed  to  arrest  fermentative  and  putrefactive 
processes,  as  every  kind  of  fermentation  depends  upon  the 
growth  and  increase  of  a  living  organism.  Various  diseases 
of  the  dental  structures  have  a  close  relationship  with  low 
organisms  in  the  morbid  processes  which  result  during  their 
progress,  and  which  are  maintained  and  developed  by  the 
presence  of  living  matter.  The  remedies  recognized  as  be- 
longing to  the  group  of  antiseptics,  when  brought  into  con- 
tact with  the  disease  germs,  which  are  constituted  of  these 
organized  forms  of  life,  have  the  power  of  destroying  their 
vitality  and  of  arresting  the  fermentative  or  putrefactive  pro- 
cess which  they  either  develop  or  promote.  The  effect  of 
escharotics  when  applied  to  a  part  of  which  the  structure  and 
vitality  are  to  be  destroyed,  is  to  produce  an  eschar  and  incite 
inflammation  and  suppuration  of  the  adjacent  tissues,  by  which 
the  slough  is  separated  from  the  living  parts. 

Medicinal  substances  are  applied  to  the  mucous  membrane 
of  the  mouth  in  the  form  of  gargles  or  mouth  washes,  lotions 
and  injections,  and  generally  for  a  local  effect. 

Medicinal  substances  are  applied  to  the  skin  for  both  a 
local  and  general  effect,  either  by  friction,  by  the  endermic,  or 
by  the  hypodermic  methods.  In  the  endermic  method,  the 
cuticle  is  usually  removed  by  the  action  of  a  blister,  and  the 
medicinal  agent  is  applied  to  the  denuded  surface  in  the  form 
of  a  powder  or  ointment,  and  is  a  useful  method  when  the 
irritability  of  the  stomach  or  difficult  deglutition  prevents 
medicines  from  being  taken  through  the  mouth. 

The  hypodermic  method  consists  in  injecting  medicines  by 
means  of  a  graduated  syringe  with  a  sharp-pointed  nozzle,  and 


92  DENTAL  MEDICINE. 


constructed  for  the  purpose,  into  a  subcutaneous  cellular 
tissue,  thus  producing  both  a  local  and  general  effect,  and  an 
impression  is  made  much  more  rapidly  than  when  the  medicine 
is  taken  into  the  stomach.  It  is  necessary  that  the  remedy 
should  be  applied  beneath  the  skin,  and  that  it  should  not  be 
injected  into  any  large  vessel;  hence  for  hypodermic  injections 
a  locality  should  be  selected  free  from  nerves  and  large  ves- 
sels. The  medicinal  agents  used  for  hypodermic  injections 
are  now  prepared  in  the  form  of  tablets  which  are  perfectly 
soluble,  and  of  considerable  strength  in  small  bulk.  They  are 
dissolved  in  pure  water  at  the  time  the  injection  is  to  be 
made,  and  great  accuracy  is  thus  obtained.  Anodynes  thus 
used  are  more  rapid  in  their  effect,  and  the  general  rule  as  re- 
gards the  quantity  is,  that  in  first  injections  the  dose  should 
be,  for  males,  two-thirds  of  the  ordinary  dose  by  the  stomach 
and  for  females,  about  one-half.  It  is  very  necessary  that  a 
vein  or  large  vessel  should  not  be  punctured  when  introducing 
the  point  of  the  syringe.  The  insertion  of  the  deltoid  muscle 
in  the  arm  is  generally  selected  as  the  place  of  injection,  and 
the  needle-point  of  the  syringe  should  not  be  inserted  too  deep 
nor  at  the  same  point  in  subsequent  injections.  Hypodermic 
injections  may  also  be  made  in  the  back,  front  or  thigh — just 
in  front  of  trochanters,  and  in  the  calf  of  the  leg. 

Medicinal  substances  of  the  classes  of  rubefacients  and 
epispastics  are  employed  as  counter-irritants ,  their  effect  being 
to  establish  external  or  artificial  irritation  for  the  relief  or  cure 
of  internal  inflammation  existing  in  a  part  or  in  the  body.  The 
extent  and  character  of  the  counter-irritation  thus  established 
should  be,  in  a  great  measure,  regulated  by  the  character  of 
the  disease  which  it  is  intended  to  relieve  ;  a  rubefacient  being 
indicated  in  irritation  of  mucous  membrane,  a  seton  or  issue 
when  the  disease  is  of  a  suppurative  character,  and  a  vesicant 
in  inflammation  of  serous  membranes. 

Setons  and  Issues  are  employed  to  produce  permanent 
counter-irritant  effects.  A  seton  consists  of  a  skein  of  silk  or 
a  piece  of  tape  or  other  substance  passed  through  the  integu- 
ment by  means  of  a  seton-needle,  and  allowed  to  remain,  so 


TOPICAL   REMEDIES.  93 


that  a  discharge  is  maintained.  A  simple  seton  in  the  case  of 
an  incision  into  an  alveolar  abscess,  is  composed  of  a  single  or 
double  strand  of  floss  silk  introduced  into  a  wound  made  by 
the  lancet,  or  into  the  orifice  of  a  fistulous  opening,  after  the 
pus  of  the  abscess  has  been  evacuated,  to  maintain  a  free  exit 
for  the  pus  which  may  be  secreted  after  the  first  operation ; 
fine  silver  wire  is  also  employed  for  the  same  purpose.  An 
issue  is  generally  some  irritating  substance,  such  as  caustic 
potassa,  or  a  small  pea,  or  piece  of  orris  root  introduced  in 
order  to  maintain  a  discharge. 

Blood-letting  is  performed  for  the  purpose  of  lessening  vascu- 
lar excitement,  reducing  inflammatory  action,  relieving  con- 
gestive pain  and  spasm,  promoting  absorption,  relaxing  the 
muscles  and  arresting  hemorrhage.  It  is  divided  into  general 
and  local,  general  blood-letting  consisting  of  venesection  or 
phlebotomy,  the  median  cephalic  or  basilic  veins  of  the  arm, 
and  occasionally  the  external  jugular  and  other  veins,  being 
the  ones  selected  from  which  to  draw  the  blood.  But  it  should 
be  resorted  to  with  caution,  as  it  is  a  powerful  and  exhausting 
agent 

Local  Blood-letting  is  chiefly  employed  for  the  relief  of  local 
inflammations  and  congestions,  and  is  accomplished  by  means 
of  leeches,  cups,  and  scarifications. 

The  leech — hinido — is  commonly  employed  as  an  agent  for 
local  blood-letting,  and  is  preferable  to  "  cupping  "  in  many  local 
and  chronic  forms  of  inflammation ;  also  in  infantile  affections 
which  require  such  an  operation,  when  the  American  leech  is 
used,  and  it  makes  a  smaller  incision  than  the  European  leech, 
and  draws  less  blood.  A  leech  is  supposed  to  draw,  on  an 
average,  about  a  drachm  and  a  half  to  two  drachms  of  blood 
before  it  is  removed,  and  the  quantity  which  subsequently  flows 
will  generally  equal  that  drawn  by  the  leech. 

Leeches  are  often  applied  to  the  gum  over  the  root  of  a  tooth 
affected  with  acute  periodontitis,  to  relieve  the  inflammation 
and  congestion.  To  make  the  leech  bite  readily,  the  surface  to 
which  it  is  to  be  applied  may  be  smeared  with  cream  or  sweet 
milk,  or  a  puncture  may  be  made  in  it,  so  as  to  draw  blood. 


94  DENTAL  MEDICINE. 


and,  to  isolate  the  part  of  the  surface  on  which  it  is  desired  to 
apply  the  leech,  a  small  hole  may  be  made  in  a  piece  of  bibu- 
lous paper,  which  will  adhere  to  a  dry  surface  of  the  gum,  and 
afford  an  opening  for  the  mouth  of  the  leech  to  approach  the 
surface. 

To  remove  a  leech,  if  it  does  not  drop  off  of  its  own  accord, 
which  they  will  generally  do  in  from  fifteen  to  twenty  minutes, 
it  may  be  sprinkled  with  a  little  cold  water  or  diluted  vinegar, 
or  powdered  sugar.  To  promote  bleeding  from  leech  bites^ 
fomentations  or  warm  dry  cloths,  or  a  cupping  glass,  may  be 
used.  To  check  the  hemorrhage  from  leech  bites,  which  is 
sometimes  excessive,  firm  pressure  may  be  made  with  the 
finger,  or  exposure  to  cold  air,  or  the  application  of  such  styp- 
tics as  alum  or  matico. 

Cupping  is  employed  when  it  is  desired  to  draw  blood  rap- 
idly, or  to  ascertain  the  exact  quantity  of  blood  drawn,  or  when 
it  is  desirable  to  make  an  impression  on  the  system.  Cupping 
is  performed  by  means  of  cupping  glasses  and  a  scarificator. 
The  glasses  are  applied  after  being  partially  exhausted  of  air, 
when  the  removal  of  the  atmospheric  pressure  produces  a  de- 
termination of  blood  to  the  capillaries  of  the  part,  and  it  is 
afterwards  easily  drawn  by  scarification. 

Scarifications  consist  of  small  incisions  made  in  inflamed 
and  congested  parts,  to  relieve  the  engorged  condition  of  the 
capillary  vessels,  and  are  sometimes  employed  to  relieve  acute 
inflammation  of  the  gums  and  mucous  membrane  of  the 
mouth, 

ELECTRICITY  AS  A  THERAPEUTIC  MEANS  IN  THE  TREAT- 
MENT OF  DISEASE. 

Electricity  is  a  powerful  agent  in  many  forms  of  nervous 
disease,  especially  in  the  treatment  of  paralysis  and  neuralgia. 

Three  forms  of  electricity  are  employed,  viz. :  The  induced 
current,  the  galvanic  current,  both  of  which  are  dynamical,  and 
the  static  current,  which  is  frictional. 

Galvanic  electricity — galvanism,  and  induced  electricity — 
faradism,  are  the   two   forms    generally  employed,  frictional 


^    THERAPEUTICS   OF   ELECTRICITY.  95 

electricity  being  but  seldom  applied.  What  is  known  as  electro- 
magnetism  is  a  form  of  induced  current,  generated  by  the  rotary 
instrument,  and  is  not  reliable.  Faradism,  so  called  from  its 
discoverer,  is  generated  by  an  instrument  which  is  capable  of 
applying  slow  or  rapid  shocks,  and  giving  what  is  denomi- 
nated a  fine,  strong,  induced  current.  It  consists  of  coils  of 
wire;  a  small  hammer  of  soft  iron,  attached  to  a  spring  ;  a  pole, 
containing  a  platinum-pointed  screw ;  the  hammer  breaking 
the  current  in  the  coil  of  wire,  and  by  rapid  vibration  pro- 
ducing shocks, 

"  The  galvanic  current  is  generated  by  a  series  of  cells,  suf- 
ficient in  number  to  cause  a  current  of  tension,  which  is  the 
resistance  offered  to  the  passage  of  a  current. 

"  One  cell  supplies  a  current,  the  poles  of  other  cells  being 
alternately  joined,  and  there  are  finally  but  two  terminal  poles." 
As  the  current  from  the  first  cell  passes  through  the  remaining 
cells,  its  power  is  increased  and  the  effect  is  governed  by  the 
number  of  cells  belonging  to  the  circuit.  There  is  also  what 
is  denominated  a  current  of  "  quantity,"  which  is  generated  by 
a  large  metallic  surface  in  the  battery  cell,  the  tension  current 
being  generated  by  a  number  of  small  metal  plates.  The  "ten- 
sion current "  serves  the  best  purpose  for  medical  use,  while 
the  "  quantity  current "  furnishes  heat,  and  is,  therefore,  adapted 
to  pur^^oses  of  electro-surgery.  The  modified  Bunsen  galvanic 
cell  is  the  best  for  medical  purposes,  although  what  is  known 
as  the  Siemens  and  Halske  cell  is  extensively  used ;  "  it  con- 
sists of  an  outer  cell  of  glass,  with  elements  of  zinc  and  copper, 
a  diaphragm  of  porous  earthenware,  and  a  diaphragm  of  papier 
mache,  between  the  solutions."  The  Holtz  electric  instrument 
furnishes  the  best  static  current. 

The  Ruhmkorff  coil  is  also  employed,  in  the  use  of  which 
but  one  wire  is  brought  in  contact  with  the  patient,  the  other 
conductor  being  formed  by  the  air,  and  a  spark,  similar  to  the 
ordinary  spark  from  the  friction  machine,  being  produced. 

When  electricity  is  applied  to  the  body,  sponges  of  differ- 
ent sizes,  or  polished  metallic  surfaces,  known  as  "  electrodes," 
the  metallic  being  the  best,  are  employed,  the  effect  upon  the 


96  DENTAL  MEDICINE. 


skin  being  similar  to  what  is  caused  by  puncturing  with  many 
small  needles.  The  theory  of  electro-therapeutics  is  dependent 
upon  the  following  effects  : — 

^'  If  a  portion  of  a  motor  nerve  is  included  between  the 
poles  of  a  galvanic  battery,  it  is  said  to  be  polarized,  and  in  a 
state  of  electrotonus.  At  the  positive  pole,  the  irritability  of 
the  nerve  is  diminished,  while  at  the  negative  it  is  excited  and 
more  susceptible  to  stimulation.  The  condition  at  the  posi- 
tive pole  is  called  anelectrotonus,  and  that  at  the  negative  cate- 
lectrotonus.  The  positive  pole  is  known  as  the  anode ;  the 
negative,  the  cathode,  and  these  give  the  name  to  the  states 
described.  A  nerve  is  said  to  be  tetanized  when  the  muscle 
supplied  is  thrown  into  a  state  of  permanent  tetanic  contrac- 
tion by  a  rapidly  intermittent  current.  The  passage  of  a 
number  of  these  shocks  for  some  time  will  diminish  the  irri- 
tability of  the  nerve  to  such  an  extent  that,  finally,  there  will 
be  no  further  response.  As  an  ascending  current  causes  a 
greater  irritability  in  a  nerve  than  a  descending  one ;  a  de- 
scending one  depresses  excitability.  The  stimulus  is  felt  at 
the  negative  pole  when  the  current  commences,  and  when  it 
is  broken  it  is  felt  at  the  positive  pole.  A  shock  is  felt  at  the 
opening  of  the  weak  currents ;  with  moderately  strong  ones 
it  is  felt  both  at  the  opening  and  the  closure.  With  very 
strong  currents,  it  is  impossible  to  tell  the  points  of  sensation, 
as  the  power  of  the  nerve  is  impaired."  The  action  upon 
involuntary  muscles  is  less  than  upon  the  voluntary,  and,  as 
regards  the  latter,  it  is  the  same,  or  nearly  so,  as  long  as  the 
integrity  of  their  immediate  nerve  supply  is  concerned. 

Degenerations  and  atrophies  of  muscles  interfere  to  a  con- 
siderable extent  with  their  susceptibility  to  electric  currents  ; 
hence,  it  is  better,  in  diseased  conditions,  to  pass  the  current 
through  the  nerve  trunk  which  supplies  them.  The  faradic 
current  has  but  a  local  effect,  the  deeper  muscles  and  nerves  . 
escaping. 

When  a  metallic  or  sponge  electrode  is  applied  to  the 
moistened  skin,  a  pricking  sensation  follows,  attended  with 
redness  and  tingling,  and  this  impression  on  the  cutaneous 


THERAPEUTICS   OF   ELECTRICITY,  97 

nerves  and  muscles  is  known  as  electro-muscular  sensibility. 
The  galvanic  current  occasions  a  sensation  of  Avarmth,  like 
that  produced  by  a  local  stimulant,  such  as  a  mustard  plaster, 
and  when  the  faradic  current  is  applied  to  the  dry  skin,  or 
when  the  electrodes  are  but  lightly  applied,  there  is  produced 
a  sensation  of  pain,  and  the  pain  is  the  greater  when  caused 
by  rapidly  succeeding  shocks  than  by  slow  ones. 

The  galvanic  current  causes  deeper  impressions  than  the  - 
faradic,  and  also  electrolytic  changes  different  from  the  faradic, 
producing  absorption  and  changing  the  structure  of  the  dif- 
ferent tissues,  and  beneficial  results  have  resulted  from  its 
application  in  diseases  of  the  brain.  The  physical  effects  of 
the  galvanic  current  upon  the  sympathetic  nerve  are  dilatation 
followed  by  contraction  of  the  pupil,  diminished  frequency  of 
the  pulse,  and  a  lowering  of  the  tension  of  the  carotid  arteries. 
When  electricity  is  used  for  the  purpose  of  diagnosis,  the 
existence  of  local  tenderness,  exalted  sensibility,  anaesthesia, 
paralysis,  diseases  of  the  brain,  spinal  cord,  etc.,  may  be  as- 
certained. It  has  also  been  used  to  determine  the  question  of 
doubtful  death,  whether  certain  affections  are  recent  or  of  long 
standing,  and  to  detect  malingering.  As  various  nervous 
diseases  are  associated  with  the  loss  of  such  functions  of 
muscles  as  contraction  and  sensation,  or  the  reverse,  electricity 
determines  the  extent  of  such  changes.     . 

When  employing  the  electric  current,  the  anatomy  of  the 
part  affected  should  be  well  understood;  for  example,  for 
neuralgia  of  the  fifth  pair  of  nerves  one  pole  should  be  applied 
as  near  as  possible  to  the  point  of  exit  of  the  nerve  from  the 
cranium,  and  the  other  pole  to  the  remote  parts  of  distribution. 

Galvanism  and  faradism  are  employed  for  the  relief  of  pain 
and  spasm,  to  improve  the  nutritive  processes,  and  to  restore 
deficient  muscular  power,  to  stimulate  sensation  in  nerves,  to 
stimulate  secretion,  to  influence  circulation,  to  cause  absorp- 
tion of  fluids,  to  bring  about  the  absorption  of  morbid  growths 
and  deposits,  to  induce  sleep,  and  in  surgery,  in  the  form  of 
the  galvanic  cautery.  The  galvanic  current  is  considered  to  be 
the  most  useful  for  the  mediate,  and  the  faradic  current  for 
7 


98  DENTAL  MEDICINE. 

the  immediate  application,  the  former  proving  serviceable  in 
all  forms  of  neuralgia,  and  especially  in  facial  neuralgia,  and 
the  latter  in  headaches,  especially  those  of  a  rheumatic  nature. 

Galvanism  is  also  employed  with  advantage  in  sciatica, 
spinal  irritation  and  hysteria,  also  tumors,  such  as  aneurisms 
and  goitre,  these  morbid  products  being  dispersed  by  connect- 
ing the  two  poles  of  a  galvanic  battery  with  needles,  which 
are  thrust  into  the  morbid  growth  and  generate  a  process 
known  as  electrolysis.  In  such  operations  bubbles  of  hydro- 
gen gas  are  disengaged  at  the  negative  pole,  which  separate 
mechanically  the  adjacent  tissues,  breaking  them  up  in  such  a 
manner  that  the  disintegrated  particles  may  be  taken  up  by 
the  circulation.  Oxygen  is  disengaged  at  the  positive  pole, 
which  forms  an  acid  with  certain  elements  of  the  tissue,  and 
the  albumen  is  coagulated,  forming  a  clot  if  this  occurs  in  a 
cavity  filled  with  blood. 

For  obtunding  sensitive  dentine  and  controlling  peridental 
inflammation  by  electrolysis,  Dr.  F.  McGraw  suggests  the  fol- 
lowing method:  "To  a  12  per  cent,  solution  of  cocaine  add 
an  equal  amount  of  absolute  alcohol.  In  connection  with 
this  use  the  galvanic  current,  varying  the  power  as  the  needs 
of  each  case  may  indicate."  The  method  of  application  is  as 
follows :  "  After  applying  the  rubber-dam,  wet  a  pledget  of 
cotton  in  the  solution;  place  it  in  the  cavity  of  the  tooth; 
press  the  point  of  the  positive  pole  on  to  the  cotton,  and  the 
negative  pole,  with  sponge  attachment,  to  the  cheek,  turning 
on  the  current.  An  application  of  three  minutes,  with  an 
interval  of  like  duration,  and  then  another  three-minute  ap- 
plicatioUj  is  sufficient  in  the  majority  of  cases,  although  it  is 
occasionally  necessary  to  make  the  third  application.  Then 
dry  the  cavity  thoroughly  and  begin  excavating."  In  case  of 
peridental  inflammation  use  a  stronger  current,  which  tetanizes 
the  vessels  and  causes  a  diminished  flow  of  blood  to  the  parts 
and  thus  lessens  congestion.  The  same  current  longer  con- 
tinued will  cause  electrolytic  decomposition,  "  The  medicinal 
agents  he  uses  for  peridental  inflammation  and  for  blind 
abscesses  are  a  saturated  solution  of  the  chloride  of  sodium, 


THERAPEUTICS   OF   ELECTRICITY.  99 

seven  ounces,  tincture  of  ergot,  one  ounce.  The  treatment  of 
blind  abscesses  requires  a  stronger  battery  power  in  order  to 
obtain  the  full  effect  of  the  electrolysis.  Dr.  Weeks  has  used 
this  method  successfully  in  the  painless  removal  of  pulps." 

Galvano-Catiteiy. — For  surgical  operations,  as  a  substitute 
for  the  knife  or  ecraseur,  a  platinum  wire  is  placed  between 
the  poles  of  a  powerful  battery,  the  wire  being  adjusted  in  a 
handle,  which  in  a  few  minutes  becomes  red  hot,  and  is  espe- 
cially serviceable  for  operations  in  deep  cavities  where  it  would 
be  impossible  to  use  the  knife,  the  application  of  such  a  gal- 
vanic cautery  being  unattended  by  pain  or  hemorrhage.  The 
Galvano-Cautery  consists  of  a  platinum  wire  loop  heated  by 
passing  a  current  of  electricity  through  it,  the  heat  being 
maintained  as  long  as  the  current  passes.  Such  an  appliance 
will  cut  through  the  tissue  to  which  it  is  applied  without 
causing  much  hemorrhage. 

Electric  portable  lamps  are  also  employed  for  illuminating 
the  mouth  and  examining  the  teeth,  and  carious  cavities  in 
them. 

Strong  currents  of  electricity  should  not  be  applied  to  the 
head,  nor  its  use  be  persevered  in  for  more  than  fifteen  minutes 
at  a  time. 

Electro-magnetism  has  been  employed  for  relieving  pain 
during  the  extraction  of  teeth,  one  pole  of  an  ordinary  battery 
being  attached  to  the  forceps  and  the  other  to  a  handle  which 
is  grasped  by  the  patient.  The  susceptibility  to  the  currenj:  is 
first  ascertained  by  the  patient  holding  both  the  forceps  and 
the  handle  in  his  hands,  and  a  feeble  shock  applied,  which  is 
gradually  increased  until  the  sensation  is  felt  at  or  just  beyond 
the  elbows,  when  the  current  is  somewhat  reduced  in  power. 
After  the  gum  has  been  lanced,  the  connection  is  made  as 
before  described,  by  the  patient  holding  the  handle  and  the 
operator  the  forceps  in  contact  with  the  tooth  to  be  removed, 
the  handles  of  the  instrument  being  isolated,  when  the  opera- 
tion is  at  once  completed.  Great  diversity  of  opinion,  how- 
ever, exists  as  to  the  efficiency  of  this  method,  which  has  its 
advocates  and  opponents. 


100  DENTAL   MEDICINE. 


INCOMPATIBILITY* 

"  Incompatibility  gives  rise  to  many  dangers  which  may  in  a 
great  measure  be  avoided  by  the  use  of  the  utmost  simpHcity 
in  prescribing.  '  The  tendency  of  the  present  age  is  toward 
mono-  rather  than  poly-pharmacy,  and  prescriptions  with  the 
orthodox  adjuvans  and  corrigens  are  less  frequently  seen  than 
formerly.'     (Piffard.) 

"  This  subject  can  only  be  glanced  at  here.  The  following 
simple  rules  may  help  the  burdened  memory  of  the  practi- 
tioner : — 

"  Never  use  more  than  one  remedy  at  a  time,  if  one  will 
serve  the  purpose. 

"  Never  use  strong  mineral  acids  in  combination  with  other 
agents,  unless  you  know  exactly  what  reaction  will  ensue. 
They  decompose  salts  of  the  weaker  acids  and  form  ethers 
with  alcohol. 

"  Select  the  simplest  solvent,  diluent  or  excipient,  you  know 
of,  remembering  that  the  solvent  power  of  alcohol  and  water, 
for  their  particular  substances,  decreases  in  proportion  to  the 
quantity  of  the  other  added. 

"  Never  combine  Free  Acids  with  hydrates  or  carbonates. 

"  Generally  do  not  combine  two  or  more  soluble  salts. 

"  The  following  more  or  less  insoluble  salts  will  be  formed 
whenever  the  materials  of  which  they  are  composed  are  brought 
together  in  solutions  :  the  Hydrates,  Carbonates,  Phosphates, 
Borates,  Arseniates  and  Tannates  of  most  earthy  and  heavy 
metals  and  alkaloids,  and  the  metallic  Sulphides  ;  the  Sulphates 
of  Calcium,  of  Lead  and  of  the  subsalts  of  Mercury :  the 
Chlorides,  Iodides  and  Bromides  of  Bismuth,  Silver,  Lead  and 
subsalts  of  Mercury;  the  Iodides  of  Quinine,  Morphine  and 
most  alkaloids. 

'^Alkalies  precipitate  the  alkaloids  and  the  soluble  non- 
alkaline  metallic  salts,  and  (as  also  metallic  Hydrates  and 
•Carbonates)  neutralize  free  acids. 

"  Silver  Nitrate,  Lead  Acetate,  Corrosive  Sublimate,  Potassium 

*S.  O.  L.  Potter,  M.D. 


I 


INCOMPATIBILITY.  IQI 


Iodide  should  nearly  always  be  prescribed  alone.  The  first 
with  Creasote  forms  an  explosive  compound.  Aconite  should 
never  be  given  in  any  vehicle  except  water. 

"  Silver  Nitrate,  and  Lead  Acetate  and  Snbacetate,  although 
incompatible  with  almost  everything,  may  be  combined  with 
Opium :  the  latter  forming  with  Opium  a  compound  which, 
although  insoluble,  is  therapeutically  active  as  a  lotion. 

"Corrosive  Sublimate  is  incompatible  with  almost  everything, 
and  should  be  given  in  Simple  Syriip  ;  even  the  Compound 
Syrup  of  Sarsaparilla  is  said  to  decompose  it. 

"  Tannic  Acid,  and  substances,  containing  it,  are  incompatible 
with  albumen  and  gelatin.  Tannic  Acid,  Iodine  and  the  soluble 
Iodides  are  incompatible  with  the  alkaloids  and  substances 
containing  them,  and  with  most  soluble  metallic  salts.  Vege- 
table Infusions  are  generally  incompatible  with  metallic  salts. 

'^  Glucosides,  such  as  Santonin  and  Colocynthin,  should  not 
be  prescribed  with  free  acids  or  Emulsin. 

"  Dangerous  Compounds,  because  poisonous,  are  :  Potassic 
Iodide  with  Potassic  Chlorate ;  Hydrocyanic  acid  or  Potassium 
Cyanide  with  metallic  Hydrates,  Carbonates,  Sub-nitrates  or 
Sub-chlorides,  as  Bismuth,  Carbonate  or  Nitrate  or  Calomel. 

"  Explosions  would  result  from  the  combination  of  powerful 
oxidizers  with  readily  oxidizable  substances,  as  Potassium 
Chlorate  or  Permanganate  with  Tannin,  Sugar,  Sulphur, 
Sulphides,  Vegetable  powders,  Glycerine,  Alcohol,  Tinctures 
or  Ether." 


102 


DENTAL  MEDICINE, 


TABLE   OF   THE   DOSES   OF   MEDICINES. 

Arranged  in  Alphabetical  Order,  and  expressed  in  terms  of  both  the  Apothecaries'  and  the 
Decimal  Metric  System  of  Weights  and  Measures. 

Revised  and  Corrected  according  to  the  New  Pharraacopoeial  Standard. 

BY  OSCAR  OLDBERG,  Ph.D. 


Remedies. 


Abstract,  aconiti 

Abstract,  aspidosperm^  .  . 
Abstract,  belladonnEe.  .  .  . 
Abstract,  cannab.  ind.  .  .  . 
Abstract,  conii  ..... 
Abstract,  coto  .... 

Abstract,  digitalis 

Abstract,  gelsemii 

Abstract,  hyoscyami  .... 

Abstract,  ignatise 

Abstract,  ipecac 

Abstract,  jalapse    ....-, 

Abstract,  nuc.  vom 

Abstract,  phytolaccas  .... 
Abstract,  pilocarpi ..... 
Abstract,  podophylli  .... 
Abstract,  sanguin.  alterat.  . 
Abstract,  sanguin.  emet.  .    . 

Abstract,  senegse 

Abstract,  valerianse  .... 

Abstract,  veratr.  vir 

Acet.  lobelias 

Acet.  opii 

Acet.  sanguinar 

Acet.  scillae 

Acid.  acet.  dil 

Acid,  arsenios 

Acid,  benzoic 

Acid,  carbolic 

Acid,  citrici 

Acid,  gallic 

Acid.  gall,  in  albuminuria.  , 
Acid,  hydrobrom.  dil.  .  .  . 
Acid,  hydrochlor.  dil.  .  .  . 
Acid,  hydrocyan.  dil.    .    .    . 

Acid,  lactic 

Acid.  nitr.  dil 

Acid,  nitro-hydrochlor.  dil.  . 
Acid,  phosphoric  dil.  .  .  . 
Acid,  salicyl 


Dose  in  metric  weights 
or  measures. 


3  to  lo  centigrams. 
0.30  to  1.20  grams 

3  to  10  centigrams. 
6  to  20  centigrams. 
6  to  20  centigrams. 
6  to  20  centigrams. 
6  to  20  centigrams. 
6  to  20  centigrams. 
1 2  to  40  centigrams 
6  to  20  centigrams. 
0.20  to  2  grams  .  . 
0.40  to  2  grams  .  . 
6  to  20  centigrams. 
0.30  to  I  gram.    . 
0.40  to  2  grams.   . 
25  to  60  centigrams 
6  to  20  centigrams. 
0.60  to  1.20  Gm.  . 
25  to  60  centigrams 
0.60  to  1.20  Gm.  . 
6  to  20  centigrams. 
I  to  4  C.  c.    .    .    . 
0.30  to  I  C.  c.  .    . 

I  to  2  C.  c. 

0.60  to  2  C.  c.  .    . 

4  to  6  C.  c.   .    .    . 

1  to  5  milligrams  . 
0.30  to  I  Gm.  .    . 

2  to  6  centigrams  . 
0.60  to  2  Gm.  .  . 
0.20  to  I  Gm.  .  . 
o.  60  to  4  Gm.  .  . 
I  to  2.50  C.  c.  .  . 
0.60  to  2  C.  c.  .  . 
o.io  to  0.30  C.  c.  . 
I  to  4  C.  c.  .  .  . 
0.60  to  2  C.  c.  .  . 
0.30  to  1.30  C.c.  . 
0.30  to  2  C.  c.  .  . 
0.30  to  I  Gm.  .    . 


Dose  in  apothecaries' 
weights  or  measures. 


1%  grains. 

20  grains. 
I/^  grains. 

3  grains. 

3  grains. 

3  grains. 

3  grains. 

3  grains. 

6  grains. 

3  grains. 
30  grains. 
30  grains. 

3  grains. 
15  grains. 
30  grains. 
10  grains. 
I    3  grains. 
•  15  grains, 
i  10  grains. 
I  15  grains. 
1    3  grains. 
I  60  minims. 
I  16  minims. 
I  30  minims. 
1  30  minims. 
I  90  minims. 
I  jL  grain. 
I  15  grains. 
I     I  grain. 
I  30  grains. 
I  15  grains. 
I  60  grains. 
I  40  minims. 
I  30  minims. 
I    6  minims. 
>  60  mmims. 
I  30  minims. 
I  20  minims. 
1  30  minims. 
I  15  grains. 


POSOLOGICAL  TABLES. 


103 


DOSE  TABLE  CONTINUED. 


Acid,  sulphuric  dil.  .  .  . 
Acid,  sulphuric  arom.  .    . 

Acid,  sulphuros 

Acid,  tannic 

Aconitina  (white  crystals) 
Aconitiiia  (Duquesnel's)  . 

^ther 

Aloe 

Alonium 

Alumen 

Ammonii  benzoas  .  .    .    . 

Ammonii  bromid 

Ammonii  carb 

Ammonii  chlorid 

Ammonii  iodid 

Ammonii  phosph 

Ammonii  valer 

Ammonii  valer.  elixir  .    . 

Amyl  nitris 

Araylum  iodatum  .  .  .  . 
Ant.  et  pot.  tartr. ;  diaph. 
Ant.  et  pot.  tartr  ;  emetic 
Apomorph.  hydrochlor.    . 

Aqua  ammoniae 

Aqua  amygd.  amar.  .    .    . 

Aqua  c amphorae 

Aqua  chlori 

Aqua  creasoti 

Aqua  laurocerasi  .    .    .    . 

Argenti  nitras 

Argenti  oxid.  .  .    .  •  .    .    . 

Asafoetida 

Atropinje  sulph 

Auri  et  sodii  chlorid.    .    . 

Bebeerinae  sulph 

Berberina  and  its  salts  .  . 
Bismuthi  et  ammon.  citr.  . 

Bismuthi  subcarb 

Bismuthi  subnitr 

Caffeinoe  citras 

Calcii  carb  ...        .    .    . 

Calcii  hypophosphis  .    .    . 

Calcii  phosphas 

Calumba 

Camphora 

Camph.  monobrom  .    .    , 

Capsicum 

Cerii  oxalas 

Chinoidinum 

Chloral 

Chlorofomium  .  .  .  .  , 
Cinchona  , 


Dose  in  metric  weights 
or  measures. 


0.36  to  2  C.  C.  .  .  . 
0.30  to  2  C.  C.  .  .  . 
2  to  4  C.   C 

10  to  60  centigrams  . 
0.15  to  0.30  milligr. 
0.30  to  0.50  milligr. 

2  to  4  C.  c 

lo  to  30  centigrams  . 
6  to  20  centigrams.  . 
0,50  to  I  Gm.  .  .  . 
0.50  to  1.30  Gm.  .  . 
0.30  to  2  Gm.  .  .  . 
20  to  60  centigrams  . 

1  to  2  Gm 

0.20  to  I  Gm.  .  .  . 
0.30  to  1.30  Gm.  .  . 
o.io  to  0.50  Gm.  .    . 

2  to  4  C.  c 

o.  10  to  0.40  C.  c.  .  . 
o.  20  to  2  Gm.  .  .  . 
4  to  10  milligrams.  . 
6  to  lo  centigrams.  . 

3  to  6  milligrams  .  . 
0.30  to  2  C.  c.  .  .  . 
10  lo  15  C.  c.  .  .  . 
15  to  60  C.  c.   .    .    . 

4  to  15  C.  c 

4  to  15  C.  c 

0.30  to  C.  c 

1  to  2  centigrams.  . 
3  to  10  centigrams.  . 
0.30  to  1.30  Gm.  .  . 
0.50  to  2  milligrams. 

2  to  4  milligrams.  .  . 
20  to  60  centigrams  . 
0.20  to  I  Gm.  .  .  . 
O.IO  to  I  Gm.  .  .  . 
0.40  to  2  Gm.  .  .  . 
0.40  to  2  Gm.  .  .  . 
6  to  30  centigrams.  . 

I  to  4  Gm 

0.20  to  I  Gm.  .    .    . 

I  to  2  Gm 

0.60  to  2  Gm.  .  .  . 
20  to  60  centigrams. 
10  to  30  centigrams. 
6  to  60  centigrams.  . 
6  to  30  centigrams.  . 
0.20  to  2  Gm.  .  .  . 
0.20  to  I  Gm.  .  .  . 
0.05  to  0.30  C.  c.  . 
I  to  4  Gm 


Dose  in  apothecaries' 
weights  or  measures. 


5  to  30  minims. 

5  to  30  minims. 
30  to  60  minims. 

2  to  10  grains. 
?k  to  do  grain. 
JOT  to  xk  gi^am. 
^  to  I  fl.  drachm. 

2  to    5  grains. 

1  to  3  grains. 
10  to  15  grains. 
10  to  20  grains. 

5  to  30  grains. 

3  to  10  grains. 
15  to  30  grains. 

3  to  15  grains. 

5  to  20  grains. 

2  to  8  grains. 
30  to  60  minims. 

'   2  to    5  minims. 

3  to  30  gi-ains. 
T6  to  Ye  grain. 

1  to    2  grains. 

6  to  30  minims. 

2  to    4  fl.  drachms. 
^  to    2  fl.  oz. 

I  to    4  fl.  drachms. 

I  to  4  fl.  drachms. 

6  to  30  minims. 
j4>  to  y(  grain. 
^  to    2  grains. 

5  to  20  grains, 
xk  to  sV  grain. 
■S2  to  tV  gi-am. 

3  to  10  grains. 
3  to  15  grains. 
I  to  15  grains. 

6  to  30  grains. 
6  to  30  grains. 

1  to  5  grains. 
15  to  60  grains. 

3  to  15  grains. 
15  to  30  grains. 
10  to  30  grains. 

3  to  ID  grains. 

2  to  5  grains. 
I  to  10  grains. 
I  to    5  grains. 

3  to  30  grains. 
3  to  15  grains. 

I  to    5  minims. 
15  to  60  grains. 


104 


DENTAL   MEDICINE. 


DOSE  TABLE  CONTINUED. 


Remedies. 

Dose  in  metric  weights 

or  measures. 

Cinchonidina,  and  its  salts  .    . 

0.06  to  2  Cm 

Cinchonina,  and  its  salts  .    .    . 

0.06  to  2  Gm 

Cinnamomum 

0.40  to  2  Gm 

3  to  10  centigrams   .    . 

4  to  10  grams    .... 

Confectio  sennse 

Convallamarin 

I  to    2  milligrams    .    . 

Copaiba 

I  to    4  C.  c 

Creasotum 

0.05  to  0  20  C.  c.  .  .  . 
I  to    5  Gm 

Creta  praepar 

Croton  chloral 

5  to  60  centigrams    .    . 

Cubeba  

I  to    4  Gm 

Cupri  sulphas 

3  to  60  centigrams    .    . 

Decoct,  hsematoxvlon  .... 

32  to  64  C.  c 

Digitalinum 

I  to    2  milligrams    .    . 

Digitalis 

3  to  10  centigrams  .  , 
0.50  to  I  milligram  .    . 

Duboisina,  and  its  salts    .    .    . 

Elaterinum;    U.S.P.,  i88o  .    . 

I  to    4  milligrams    .    . 

Elaterium;   U.S.P.,  1S70    .    . 

4  to  30  milligrams    .    . 

Ergotinum •  .    .    , 

10  to  50  centigrams  .  , 
I  to    3  milligrams    .    . 

Eserina  and  its  salts  .... 

Eserina  muriat 

I  to    6  milligrams    .    . 

Eucalyptus 

4  to  16  Gm 

Eupatorium 

I  to    4  Gm 

Extr.  aconiti  rad.,  U.S. P.,  1880 

5  to  15  milligrams    .    . 

Extr.  aromat.  fl '  . 

2  to    4  C.  c 

Extr.  bellad.  fol.  (Eng.)  ,  ,    . 

I  to    4  centigrams    .    . 

Extr.  bellad.  alcohol     .... 

1  to    3  centigrams    .    . 

Extr.  bellad.  fol.  fl 

0.20  to  0.40  C.  c.      .    . 

Extr.  bellad.  rad.  ...'... 

8  to  15  milligrams    .    . 

Extr.  bellad.  rad.  fl 

o.io  to  0.20  C.  c.      .    . 

Extr.  berber.  aquifol.  fl.    ,    .    . 

I  to    2  C.  c 

Extr.  buchu  fl 

2  to  10  C.  c 

Extr.  calami  fl 

I  to    4  C.  c 

Extr.  calumbcC 

0  to  60  centigrams    .    . 

Extr.  calumbse  fl 

I  to    4  C.  c 

Extr.  cannab.  Amer.  fl.    .    .    . 

0.20  to  I  C.  c 

Extr.  cannab.  ind 

I  to    3  centigrams    .    . 

Extr.  cannab.  ind.  fi 

0.20  to  0.40  C.  c.  ,    .    . 

Extr.  cantharidis  fl 

0.06  to  0.20  C.  c.  .  .    . 

Extr.  capsici  fl 

0.06  to  0.20  C.  c.  .    .    . 

Extr.  cardam.  comp.  fl.    .    .    . 

I  to    3  C.  c 

Extr.  carnis 

I  to    4  Gm 

Extr.  cascarillas  fl 

3  to  10  C.  c 

Extr.  catechu  liquid 

0.50  to  2  C.  c 

Extr.  chimaph.fl 

3  to    5  C.  c 

Extr.  chiratx-  fl • .    . 

2  to    5  C.  c 

Extr.  cimicifugje  fl 

0.50  to  2  C.  c 

Extr.  cinchonse 

I  to    2  Gm 

Extr.  cinchonae  fl 

2  to    4  C.  c 

Extr.  cinchonae  arom.  fl.  .    .    . 

2  to    4  C.  c 

Extr.  cinchonae  comp.  fl.  .  .    . 

2  to    5  C.  c 

Extr.  colch.  rad 

2  to  10  centigrams  .    . 

Dose  in  apothecaries' 
weights  or  measures. 


o  30  grams. 
0  30  grains, 
o  30  grains, 
o  2  grains. 
o  120  grains. 
o  sV  g':ai_n. 
016  minims. 

3  minims. 
;o  75  grains. 
o  10  grains. 
o  60  grains, 
o  10  grains. 
o  2  fl.  ounces. 
o  TsV  grain. 

2  grains. 

to  eV  g^^ii^- 
o  Jj  grain. 
o  >|  grain. 
o  6  grains. 
o  2V  grain, 
o  J-Q  gram. 
o    4  drachms. 
o  60  grains, 
o  }i  giain. 
o  60  minims. 
'4,  grain. 

o  X  g''^"^- 

o  6  minims. 

o  X  grain. 

o  3  minims. 

o  30  minims. 

o  2 14  fl.  drachms. 

o  60  minims. 

0  10  grains. 

,0  60  minims. 

015  minims. 

o  yi  grain. 

6  minims. 
0    3  minims, 
o    3  minims, 
o  45  minims, 
o  60  grains. 
;o    2^  fl.  drachms, 
o  30  minims, 
o  iJ4^  fl.  drachms, 
o  Ij^  fl.  drachms, 
o  30  minims, 
o  30  grains, 
o  60  minims, 
o  60  minims. 
,0     iX  fl-  drachms. 

i^  grains. 


POSOLOGICAL  TABLES. 


105 


DOSE  TABLE  CONTINUED. 


Remedies. 


Extr.  colch.  rad.  fl 

Extr.  colch.  sem.  fl 

Extr.  colocynth  comp 

Extr.  conii  fol.  ale. ;  U.S. P.,  70 
Extr.  con.  [fr.]  ale.  U.S.P.,  80  . 

Extr.  conii  fol.  fl 

Extr.  con.  [fr.]  fl.;  U.S.P.,  80 
Extr.  convallarise  rad.  fl.  .    .    . 

Extr.  coptidis  fl 

Extr.  corn.  flor.  fl 

Extr.  cubebse  fl 

Extr.  digitalis 

Extr.  digitalis  fl 

Extr.  ergotse 

Extr.  ergotse  fl 

Extr.  erythroxyli  fl 

Extr.  eucalypti 

Extr.  eucalypti  fl 

Extr.  eupatorii  fl 

Extr.  gelsemii  fl 

Extr.  gent.     . 

Extr.  gent.  fl. 

Extr.  geranii  fl 

Extr.  gossypii  fl 

Extr.  granati  rad.  cort.  fl.     .    . 

Extr.  grind,  rob.  fl 

Extr.  guaranaa  fl.       ..... 

Extr.  hsemotoxyli 

Extr.  helleb.  nigris 

Extr.- humuli  fl 

Extr.  Hydrastis  fl 

Extr.  hyoscyami  (Engl.)  .    .    . 

Extr.  hyoscyami  ale 

Extr.  hyoscyami  fol.  fl.     .    .    . 
Extr.  hyoscyami  sem.  fl.  .    .    . 

Extr.  ignatice 

Extr.  ignatire  fl 

Extr.  ipecac  fl 

Extr.  jaborandi  fl 

Extr.  jalapie;  U.  S.  P.,  1870   . 

Extr.  jalapas  ale 

Extr.  jalapEe  fl 

Extr.  junip.  fl 

Extr.  kamali  fl 

Extr.  kino,  liquid 

Extr.  krameria: 

Extr.  kramerire  fl 

Extr.  lactucarii  fl 

Extr.  lupulini  fl 

Extr.  malti 

Extr.  maiTubii  fl 

Extr.  matico  fl 


Dose  in  metric  weights 
or  measures. 


o.io  to  to  0.30  C.  C. 
o.  10  to  0.60  C.  C. 
10  to  30  centigrams 

5  to  10  centigrams 
2  to  6  centigrams 
0.20  to  I  C.  c.  .  , 
0.10  to  0.30  C.  c. 

1  to    2  C.  c.  .  .    . 

2  to  4  C.  c.  .  . 
2  to  4  C.  c.  .  . 
I  to  2  C.  c.  ,  .  . 
I  to  3  centigrams 
0.10  to  0.40  C.  c. 

10  to  50  centigrams 

1  to    4  C.  c.  .  .    . 

2  to  8  C.  c.  .  .  . 
0.06  to  I  Gm.  .    .    , 

1  to    4  C.  c.  .  .    .    , 

2  to  4  C.  c.  .  .  . 
o.  10  to  0.50  C.  c. 

6  to  30  centigrams 

2  to    4  C.  c 

I  to    2  C.  c.  .  .    .    , 

1  to    3  C.  c.  .  .    .    , 

3  to    8  C.  c.  .  .    ,    , 

2  to    4  C.  c.  .  .    . 

1  to  2  C.  c.  .  .  . 
050  to  2  Gm.  .    .    , 

3  to  20  centigrams   , 

2  to  4  C.  c.  .  ,  .  . 
0.50  to  2  C.  c.  .  .  , 
5  to  25  centigrams  , 
5  to  10  centigiams  , 
0.20  to  I  C.  c.  .  .  , 
0.10  to  0.50  C.  c.  , 
2  to  8  centigrams  , 
0.05  to  0.30  C.  c.  , 
0.20  to  4  C.  c,  .  , 
2  to  8  C.  c.  .  .  .  , 
30  to  60  centigrams 
20  to  40  centigi-ams 

1  to    4  C.  c 

2  to    4  C.  c 

2  to    4  C.  c 

1  to    2  C.  c 

0.30  to  I  Gm.  .    .    , 

2  to  4  C.  c.  .  ,  .  , 
0.50  to  2  C.  c.  .  .  , 
0.30  to  I  C.  c.  .  .  , 
5  to  10  Gm.   .  .    .    , 

4  to    8  C.  c 

2  to    4  C.  c 


Dose  in  apothecaries' 
weights  or  measures. 


2  to 

I^ 

I 

3 
I 

15 
30 
30 
15 

/6 

I 

I 

15 

% 
I 

15 
30 

I 

I 
30 
15 
15 

30 
15 


5  mmims. 
to  10  minims. 
to    5  grains. 

I^  grains. 

1  grain. 
15  minims. 

to  5  minims. 
30  minims. 
60  minims, 
60  minims. 
30  minims. 
Yo,  grain. 

6  minims, 
to    8  grains. 
60  minims. 

2  fl.  drachms. 
20  grains. 
60  minims, 
60  minims, 
8  minims, 

5  gi-_ains. 
60  minims. 
30  minims. 
45  minims. 

2  fl.  drachms. 
60  minims. 

30  minims. 
30  giains. 

3  grains. 
60  minims. 
30  minims, 

4  grains. 
2  grains. 

15  minims. 

8  minims, 

"X  grains, 

6  minims, 
60  minims. 

2  fl.  drachms, 
10  grains, 

6  grains. 
60  minims, 
60  minims, 
60  minims. 
30  minims. 
15  grains. 
60  minims, 
30  minims, 
15  minims. 

2^  drachms. 

2  fl.  drachms. 
60  minims. 


106 


DENTAL  MEDICINE. 


DOSE  TABLE  CONTINUED. 


Remedies. 


Extr.  nuc.  vom.  alcohol    .    . 

Extr.  opii 

Extr.  papaveris 

Extr.  papaveris  fl 

Extr.  pareirje  fl 

Extr.  physostigmse    .    .    .    . 

Extr.  piper  nigr.  fl 

Extr.  podophylii 

Extr.  prun.  virg.  fl 

Extr.  pulsatillse  fl 

Extr.  quassiee 

Extr.  quassias  fl 

Extr.  quercus  fi 

Extr.  rhei 

Extr.  rhei  fl 

Extr.  ricini  fol.  fl 

Extr.  rubifl '  . 

Extr.  rutse  fl 

Extr.  sabbatife  fl 

Extr.  sabinae  fl 

Extr.  sarsap  fl 

Extr.  sassafras  fl 

Extr.  scoparii  fl 

Extr.  Scutellariae  fl 

Extr.  senegse  fl 

Extr.  sennse  fl 

Extr.  serpent,  fl 

Extr.  spigeliis  fl 

Extr.  spigelise  et  sennas  fl.   . 

Extr.  stillingise  fl 

Extr.  stillingise  comp.  fl.  .  . 
Extr.  stramonii  (Engl.)  .  . 
Extr.  stramonii  fol.  ale.  .  . 
Extr.  stramonii  sem  .    .    .    . 

Extr.  sumbul  fl 

Extr.  taraxaci 

Extr.  taraxaci  fl 

Extr.  ustilag.  maid.  fl.     .    . 

Extr.  uvse  ursi  fl 

Extr.  valer 

Extr.  valer.  fl. 

Extr.  veratr.  vir.  fl 

Extr.  viburni  opuli  fl.  .  .  . 
Extr.  viburni   [prunifol.]  fl. 

Extr.  zingiberis  fl 

Eel  bovis  purif. 

Ferri  arsen 

Ferri  carb.  sacch 

Ferri  chlorid 

Ferri  citr 

Ferri  et  ammon.  citr.  .  .  . 
Ferri  et  ammon.  sulph.     .    , 


Dose  in  metric  weights 
or  measures. 


I  to  3  centigrams 
I  to  3  centigrams 

3  to  12  centigrams 

1  to  3  C.  c.   .    ,    . 

2  to  4  C.  c.   .    .    . 

4  to  lo  milligrams 

1  to  3  C.  c.   .    .    . 

3  to  lO  centigrams 

2  to  4  C.  c.  .  .  . 
o.io  to  0.30  C.  c.  . 

6  to  30  centigrams 

2  to  4  C.  c.  .    .    . 

2  to  4  C.  c.  .    .    . 

0.30  to  I  Gm.     .    . 

1  to  3  C.  c.  .    .    . 

2  to  8  C.  c.  .  .  . 
I  to  4  C.  c.  .    .    . 

1  to  2  C.  c.  .    .    . 

2  to  4  C.  c.  .  .  . 
0.30  to  I  C.  c.    .    . 

2  to  8  C.  c.  .  .  . 
2  to  8  C.  c.  .  .  . 
2  to  4  C.  c.  .  .  . 
2  to  8  C.  c.  .  .  . 
0.50  to  I  C.  c.     .    . 

4  to  15  C.  c.  .  . 
2  to  4  C.  c.   .    .    , 

1  to  4  C.  c.   .    .    . 

2  to  8  C.  c.  .  .  . 
2  to  8  C.  c.   .    .    . 

2  to  8  C.  c.   ,    .    , 

3  to  6  centigrams 
2  to  4  centigrams 
I  to  3  centigrams 

1  to  4  C.  c.  .  .  . 
0.30  to  I  Gm.     .    . 

2  to  8  C.  c.   .    .    . 

1  to  4  C.  c.   .    .    . 

2  to  4  C.  c.  .  .  . 
o.  30  to  I  Gm.     .    . 

2  to  4  C.  c.  .  .  . 
0.6  to  0.30  C.  c.     . 

4  to  8  C.  c.   .    .    . 

4  to  8  C.  c.  .  .  . 
0.50  to  2  C.  c.  .  . 
20  to  40  centigrams 

6  to  12  milligrams 
0.25  to  X  Gm.     .    . 

5  to  20  centigrams 
30  to  6c  centigrams 
30  to  60  centigrams 
30  to  60  centigrams 


Dose  in  apothecaries' 
weights  or  measures. 


to  y^  grain, 
to  ^  grain, 
to    2  grains, 
to  45  minims. 
to  60  minims. 
to  ^  grain. 
to  45  minims, 
to  l^  grains, 
to  60  minims, 
to     5  niinims. 
to     5  grains, 
to  60  minims, 
to  60  minims. 
to  15  grains, 
to  45  minims, 
to    2  fl.  drachms, 
to  60  minims, 
to  30  minims, 
to  60  minims, 
to  15  minims, 
to    2  fl.  drachms, 
to    2  fl.  drachms, 
to     I  fl.  drachm, 
to    2  fl.  drachms, 
to  15  minims, 
to    4  fl.  drachms, 
to  60  minims. 
to  60  minims. 
to    2  fl.  drachms. 
to    2  fl.  drachms, 
to    2  fl.  drachms, 
to     I  grain. 
to  2^  grain, 
to  y^  grain, 
to  60  minims, 
to  15  grains, 
to    2  fl.  drachms, 
to  60  minims, 
to  60  minims, 
to  15  grains, 
to  60  minims, 
to    5  minims, 
to    2  fl.  drachms. 
to    2  fl.  drachms, 
to  30  minims, 
to    6  grains, 
to    i  grain. 
to  15  grains. 
to    3  grains. 
to  10  grains, 
to  10  grains. 
to  lo  grains. 


POSOLOGICAL   TABLES. 


107 


DOSE  TABLE  CONTINUED. 


Remedies. 


Ferri  et  ammon.  tartr.  , 
Ferri  et  cinchonid.  citr.  . 
Ferri  et  pot.  tartr.  .  ,  . 
Ferri  et  quin.  citr.  .  .  . 
Ferri  et  stryclm.  citr.  .  , 
Ferri  ferrocyanid  .... 
Ferri  hypophosphis  .    .    , 

Ferri  lactas 

Ferri  oxalas 

Ferri  oxid.  hydrat.    .    .    . 

Ferri  phosphas 

Ferri  pyrophosphas  .    .    . 

Ferri  subcarb 

Ferri  sulphas 

Ferri  sulphas  exsiccat  .    . 

Ferri  valer 

Ferrum  dialys 

Ferrum  reduct 

Gentiana 

Hydrarg.  chlorid.  corros, 
Hydrarg.  chlorid.  mite.  . 
Hydrarg.  cyanid.  .  .  . 
Hydrarg.  iodid.  rubr.  .  . 
Hydrarg.  iodid.  vir.  .  . 
Hydrarg.  subsulphas  flav. 
Hydrarg.  c.  creta  ,  .  . 
Infusum  brayeras  ,  .  .  . 
Infusum  catechu  comp.  . 
Infusum  columbte  .  .  . 
Infusum  digitalis  .... 
Infusum  eupatoris  .  .  . 
Infusum  gentiana  comp.  . 
Infusum  pruni  Virginians. 
Infusum  quassise  .... 
Infusum  senniE  comp.  .    , 

Ingluvin 

lodoformum 

lodum 

~t  expect.  . 

J  emet. .    . 

Jalapa 

Kamala 

Kino 

Lactucarium 

Liq.  ammon.  acet.  .  .  . 
Liq.  arsen.  et  hydr.  iod.  . 

Liq.  ferri  nitrat 

Liq.  iodi.  comp 

Liq.  magnes.  citratis  .  . 
Liq."  pepsina  ....        . 

Liq.  potassfE 

Liq.  potassii  arsenit  .    .    . 


Ipecacuanha 


Dose  in  metric  weights 
or  measures. 


0.30  to  I  Gm.     .    . 

30  to  60  centigrams 
I  to    4  Gm.      .    . 

30  to  60  centigrams 
5  to  30  centigrams 

20  to  30  centigrams 

30  to  60  centigrams 
5  to  20  centigrams 
5  to  20  centigrams 

15  to  60  Gm.  .  . 
5  to  30  centigrams 
5  to  30  centigrams 

0.30  to  2  Gm.  .  . 
5  to  20  centigrams 
3  to  10  centigrams 

5  to  20  centigrams 
0.60  to  4  C.  c.    .    . 

6  to  30  centigrams 
0.60  to  2  Gm.     .    . 

I  to    6  milligrams 
I  to  50  centigrams 

3  to     6  milligrams 

4  to  30  milligrams 
I  to    6  centigrams 

15  to  60  milligrams 
15  to  50  centigrams 
60  to  250  C.  I 
30  to  60  C.  c 
15  to  60  C.  c 
8  to  15  C.  c 
30  to  60  C.  c 

4  to  30  C.  c 
15  to  60  C.  c 

8  to  60  C.  c, 
30  to  60  C.  c. 
0.30  to  I  Gm, 

5  to  20  centigrams 
I  to  3  centigrams 
I  to  6  centigrams 
I  to  2  Gm. 
I  to  2  Gm. 
4  to    8  Gm. 

0.50  to  2  Gm. 
0.50  to  I  Gm. 

8  to  30  C.  c. 
o.io  to  0.50  C 
0.50  to  I  C.  c. 
0.30  to  I  C.  c. 
60  to  250  C.  c 

8  to  15  C.  c. 
0.30  to  I  C.  c. 
0.15  to  0.50  C.  c. 


Dose  in  apothecaries' 
weights  or  measures. 


to  15  grains, 
to  10  grains, 
to  60  grains. 
to  10  grains, 
to    5  grains, 
to    5  grains, 
to  10  grains, 
to    3  grains, 
to    3  grains, 
to    2  ounces, 
to     5  grains, 
to     5  grains. 
to  30  grains, 
to    3  grains, 
to     ij^  grains, 
to  3  grains, 
to  60  minims, 
to    5  grains. 
to  30  grains. 
to  TO  g'"ain. 
to    8  grains. 
to  j\j  grain, 
to  )4  grain, 
to     I  grain. 
to     I  grain, 
to    8  grains, 
to    8  fl.  ounces, 
to    2  fl.  ounces, 
to    2  fl.  ounces. 
to    4  fl.  drachms, 
to    2  fl.  ounces, 
to    8  fl.  drachms, 
to    2  fl.  ounces, 
to    2  fl.  ounces, 
to    2  fl.  ounces, 
to  20  grains, 
to    3  grains. 
to  )4  grain. 
to     I  grain, 
to  30  grains, 
to  30  grains. 
to    2  drachms, 
to  30  grains, 
to  15  grains. 
to    8  fl.  drachms, 
to    7  minims, 
to  15  minims, 
to  20  minims, 
to    8  fl.  ounces, 
to    4  fl.  drachms, 
to  20  minims, 
to    7  minims. 


108 


DENTAL   MEDICINE. 


DOSE  TABLE  CONTINUED. 


Remedies. 


Liq.  potassii  citrat.    .    .    . 

Liq.  sodse 

Liq.  sodii  arseniatis  .    .    . 

Lithii  benzoas 

Lithii  bromid 

Lithii  carb 

Lithii  citr 

Lithii  saHcylas 

Lupuhnum    

Magnesia 

Magnesii  carb 

Magtifsii  citr.  gran.  .  . 
Magnesii  sulphas  .... 
Magnesii  sulphis  .... 
Mangani  sulphas  .... 

Manna   .    .        

Massa  copaibse 

Massa  ferri  carb 

Massa  hydrarg  ... 
Mist,  aramoniaci  .... 
Mist,  asafcetidse    .... 
Mist,    camphora    (Hopis) 
Mist,  chloroformi  .... 

Mist,  cretae 

Mist,  ferri  comp 

Mist,  ferri  et  ammon.  acet. 
Mist,  glycrrh.  comp.  .  . 
Mist,  magnes.  et  asafoet.  . 
Mist,  potassii  citr.  .  .  . 
Mist,  rhei  et  sodee  .  .  . 
Morphina  and  its  salts  .    . 

Moschus 

Mucil.  acacise 

Narceina 

Nitroglycerinum  .... 

Nux  vomica 

Oleoresina  aspidii  .  .  . 
Oleoresina  capsici  .  .  . 
Oleoresina  cubebse  .  .  . 
Oleoresina  lupulini  .    .    . 

Oleoresina  pipeiis 

Oleoresina  zingiberis    .... 

Oleum    copaibse 

Oleum  cubebas 

Oleum  eucalypti 

Oleum  morrhua 

Oleum  phosphoratum  .... 

Oleum  ricini 

Oleum  sabinse 

Oleum  terebinth 

Oleum  tiglii 

Opium  (14  per  cent,  morphine) 


Dose  in  metric  weights 
or  measures. 


Dose  in  apothecaries' 
weights  or  measures. 


8  to  15  C.  C.  .  . 
0.30  to  I  C.  c.  .  . 
0.15  to  0.50  C.  c.  . 
10  to  30  centigrams 

6  to  30  centigrams 
TO  to  40  centigrams 
10  to  30  centigrams 
10  to  50  centigrams 
30  to  60  centigrams 

I  to    4  Gm.  .    .    . 

I  to    4  Gm.  .    .    . 

8  to  30  Gm.  .    .    . 

8  to  30  Gm.  .  .  . 
0.50  to  2  Gm.  .  . 
10  to  60  centigrams 
30  to  60  Gm.  .  .  . 
0.30  to  2  Gm.  .  . 
0.30  to  I  Gm.  .  . 
0.06  to  I  Gm.  .  . 
15  to  30  C.  c.  .  . 
15  to  30  C.  c.     .    . 

4  to  32  C.  c.  .  .  . 
15  to  30  C.  c. .  .  . 
30  to  60  C.  c.  .  .  . 
15  to  60  C.  c.  .    .    . 

15  to  30  C.  c.    .    . 

4  to  15  C.  c. .    .    . 

4  to  15  C.  c. .  .  . 
15  to  60  C.  c. .  .  . 
15  to  30  C.  c.  .    .    . 

4  to  30  milligrams 
o.  10  to  I  Gm.     .    . 

4  to  32  C.  c.  .  . 
I  to  10  centigrams 
I  to    4  milligrams 

5  to  30  centigrams 
I  to    4  C.  c. 

D.o6  to  0.30  C.  c.  . 
0.30  to  2  C.  c.  .  . 
0.30  to  I  C.  c.  .  . 
3.o6  to  0.20  C.  c.  . 
D.o6  to  0.20  C.  c.  . 
0.50  to  I  C.  c.  .  . 
3.30  to  I  C.  c.  .  . 
o.6o  to  2  C.  c.     ,    . 

4  to  16  C.  c.  .  . 
0.05  to  o  20  C.  c.  . 

4  to  32  C.  c. 
0.06  to  0.20  C.  c     . 
0.30  to  2  C.  c.     .    . 
0.30  to  o.  10  C.  c.  . 

I  to  10  centigrams 


2  to 
Sto 

3  to 
2  to 

1  to 

2  to 
2  to 
2  to 

Sto 
15  to 
15  to 

2  to 
2  to 

8  to 

2  to 

I  to 
5  to 
5  to 
I  to 

4  to 
4  to 
I  to 

4  to 
I  to 

}4to 

K  to 
I  to 

1  to 

'A  to 

%  to 
xVto 

2  to 

I  to 
>€to 
^^?to 

I  to 
15  to 

I  to 

5  to 
5  to 
I  to 
I  to 
Sto 
5  to 

10  to 
I  to 
I  to 
I  to 
I  to 
5  to 
Vito 
>^to 


4  fl.  drachms. 
15  minims. 

7  minims. 

5  grains. 

3  grains. 

6  grains. 
5  grains. 

8  grains. 
10  grains. 
60  grains. 
60  grains. 

8  drachms. 

8  drachms. 
30  grains. 
10  grains. 

2  ounces. 
30  grains. 
15  grains. 
15  grains. 

8  fl.  drachms. 

8  fl.  drachms. 

8  fl.  drachms. 

8  fl.  drachms. 

2  fl.  ounces. 

2  fl.  ounces. 

1  fl.  ounce. 

4  fl.  drachms. 

4  fl.  drachms. 

2  fl.  ounces, 

1  fl.  ounce. 
Yi  grain. 

15  grains. 
8  fl.  drachms. 

2  grains. 

5  grams. 
60  minims. 

3  minims. 
30  minims. 
20  minims. 

3  minims. 

3  minims. 
15  minims. 
15  minims. 
30  minims. 

4  fl.  drachms. 
3  minims. 

8  fl.  drachms. 

3  minims. 
30  minims. 

2  minims. 
xy^  grains. 


POSOLOGICAL  TABLES. 


109 


DOSE  TABLE  CONTINUED 


Remedies. 


Pancreatine 

Pepsinum  purum  .... 
Pepsinum   saccharatum    . 

Phosphorus    

Pilocarpina  (and  sahs)    . 

Pil.  aloes 

Pil.  aloes  et  asafcet  .  .  . 
Pil.  aloes  et  ferri  .... 
Pil.  aloes  et  mast  .... 
Pil.  aloes  et  myiThse  .  . 
Pil  antimon.  comp.  .  .  . 
Pil.  asafoetidfe  .  .  .  . 
Pil.  cathart.  comp.    .    .    . 

Pil.  ferri.  comp 

Pil.  ferri.  iodidi  .... 
Pil.  galbani  comp.    .    .    . 

Pil.    opii 

Pil.  phosphori   .... 

Pil.  rhei 

Pil.  rhei  comp 

Plumbi  acetas 

Plumbi  iodidum    .... 

Potassii  acetas 

Potassii  bicarb 

Potassii  bitartr 

Potassii  bromid     .... 

Potassii  carb 

Potassii  chloras     .... 

Potassii  citras 

Potassii  cyanid 

Potassii  et  sodii  tailr.  .  . 
Potassii  hypophosphis  .    . 

Potassii  iodid 

Potassii  nitras 

Potassii  sulphas  .... 
Potassii  sulphidum  .  .  . 
Potassii  sulphis      .... 

Potassii  tartras 

Prunus  Virginianum     .    . 

Pulv.  aromat 

Pulv.  crette  comp.  .  .  . 
Pulv.  effervescent  aperient 

(seidlitz  powder) 
Pulv.  glycyrrh.  comp.  .    . 
Pulv.  ipecac,  et  opii     .    . 
Pulv.  jalap^e  comp.  .    .    . 

Pulv.  rhei  comp 

Quassia 

Quinidina  (and  salts)  .  . 
Quinina  (and  salts)  .    .    . 

Resina  jalapre 

Resina  podophylli    .    .    . 


Dose  iu  metric  weights 
or  measures. 


2  to 
I  to 

1  to 

2  to 
I  to 
I  to 

1  to 

2  to 

I  to 
I  to 
I  to 

1  to 

2  to 
2  to 


0.30  to  I  Gm.     .    . 

I  to  15  Gm.  .    .    . 

0.60  to  I  Gm.     .    . 

0.50  to  3  milligrams 

I  to  30  milligrams 

I  to    3  pills  .    .    . 

5  pills  .    .    . 

3  pills  .    .    . 

3  pills  .    .    . 

5  pills  .... 

3  pills  .    .    . 

6  pills  .    .    . 

4  pills  .    .    . 

5  pills  .    .    . 

4  pills  ... 

5  pills  ... 
2  pills  .    .    .    , 

4  pills  .    .    .    , 

5  pills  ... 
5  pills  .    .    . 

3  to  20  centigrams  , 

3  to  20  centigrams  . 
I  to    4  Gm.  . 

0.50  to  4  Gm.     .    . 

I  to  8  Gm.    ,    .    . 
0.50  to  4  Gm.     .    . 
0.50  to  2  Gm.     .    ,    , 
0.50  to  2  Gm.     .    . 

I  to    4  Gm.  ... 

4  to    8  milligrams 
15  to  30  Gm.      .    .    , 
0.30  to  I  Gm.     .    . 
o.io  to  I  Gm.     .    . 
0.50  to  I  Gm.     .    . 

4  to  15  Gm.  .    .    . 

5  to  60  centigrams 

1  to    2  Gm.  ,    .    . 

5  to  30  Gm.  .    .    .    , 

2  to    4  Gm,  .    .    .    , 
0.50  to  2  Gm.     .    . 
0.50  to  2  Gm.     .    . 


2  to  4  Gm.  .  .  . 
0.30  to  I  Gm.     .    . 

2  to    4  Gm.  .    .    . 

2  to  4  Gm.  .  .  . 
0.60  to  4  Gm.  .  . 
0.05  to  2  Gm.  .  . 
0.05  to  2  Gm.  .  . 
10  to  30  centigrams 

8  to  30  centigrams 


Dose  in  apothecaries' 
weights  or  measures. 


5  to  20  grains. 
15  grains  to  ^  ounce. 
10  to  20  grains. 
xk  to  aV  grain. 
i-i  to  Yz  grain. 

1  to    3  pills. 

2  to  5  pills. 
I  to    3  pills. 

1  to    3  pills. 

2  to  5  pills. 
1  to  3  pills. 
I  to    6  pills. 

1  to    4  pills. 

2  to  5  pills. 
I  to  4  pills. 
I  to  5  pills. 
I  to    2  pills. 

1  to    4  pills. 

2  to  5  pills. 
2  to    5  pills. 

^  to  3  grains, 
i^  to  3  grains. 
15  to  60  grains. 

8  to  60  grains. 
15  to  120  grains. 

8  to  60  grains. 

8  to  30  grains. 

8  to  30  grains. 
15  to  60  grains. 
tV  to  yi  grain. 
^  to    I  ounce. 

5  to  15  grains. 

2  to  15  grains. 

8  to  15  grains. 

I  to    4  drachms. 

I  to  lo  grains. 
15  to  30  grains. 

I  to    8  drachms. 
^  to     1  drachm. 

8  to  30  grains. 

8  to  30  grains. 

Chart,  No.  I. 

30  to  60  grains. 

5  to  15  grains. 
30  to  60  grains. 
30  to  60  grains. 
10  to  60  grains. 

I  to  30  grains. 

1  to  30  grains. 

2  to  5  gi-ains 
yiio  y2  grain. 


110 


DENTAL  MEDICINE. 


DOSE  TABLE  CONTINUED. 


Remedies. 


Resina  scammonii 

Rheum 

Salicinum  .  .  .  . 
Santonica  .... 
Santoninum  .  .  . 
Sapo 


Scammomum 

Senna    

Sodii  acetas 

Sodii  arsenias 

Sodii  benzoas 

Sodii  bicarb 

Sodii  bisulphis , 

Sodii  boras 

Sodii  bromid , 

Sodii  carb 

Sodii  carb.  exsicc.    .    .    .    , 

Sodii  chloras , 

Sodii  hypophosphis  .    .    .    , 
Sodii  hyposulphis     .    .    .    , 

Sodii  iodidum , 

Sodii  phosphas      .... 

Sodii  salicylas , 

Sodii  santoninas   .    .    .    .    , 

Sodii  sulphas , 

Sodii  sulphis 

Spir.  aether,  comp .... 
Spir.  sether.  nitrosi  ... 
Spir.  ammonite  .... 
Spir.  ammonise  arom.  .  . 
Spir.  camphorse  .... 
Spir.  chlorofonni  .  .  . 
Spir.  frumends      .... 

Spir.  vini  gallici 

Spir.  juniper 

Spir.  lavend.  comp.      .    . 

Spir.  menth.  pip 

Strychnina  (and  salts)  .    . 

Succus  conii 

Succus  limonis 

Sulphur 

Syrupus  calcii  lactophos. 

Syrupus  calcis 

Syrupus  ferri  bromidi  .  . 
Syrupus  ferri  iodidi  .  .  . 
Syr.  fer.  manganese  iodidi 
Syrupus  ferri  oxidi  .  .  . 
Syrupus  ferri  hypophosph. 
Syr.  fer.  quin.  et  str.  phos. 
Syrupus  hypophosphit.  . 
Syrupus  hypophos.  c.  fer. 
Syrupus  ipecac 


Dose  in  metric  weights 
or  measures. 


loto  60  centigrams 
o.io  to  2  Gm.  .  . 
0.50  to  2  Gm.  .  . 
0.50  to  4  Gm.     .    . 

6  to  30  centigrams 
0.30  to  2  Gm.  .  . 
0.20  to  I  Gm.  .  . 
0.50  to  4  Gm.     .    . 

I  to  4  Gm.    .    .    . 

1  to  6  milligrams 
0.30  to  I  Gm.  .  . 
0.50  to  2  Gm.  .  . 
0.50  to  2  Gm.  .  . 
0.50  to  2  Gm.  .  . 
0.50  to  2  Gm.  .  . 
0.50  to  2  Gm.  .  . 
0.30  to  I  Gm.  .  . 
0.30  to  2  Gm.  .  . 
0.50  to  I  Gm.  .  . 
0.50  to  2  Gm.  .  . 
0.30  to  I  Gm.  .  . 
0.10  to  I  Gm.  .  . 
0.30  to  2  Gm.  .  . 
15  to  60  centigrams 

4  to  30  Gm.  .  .  . 
0.50  to  2  Gm.     .    . 

2  to  4  C.  c.  .  .  . 
2  to  8  C.  c.  .    .    . 

0.50  to  2  C.  c.    .    . 

I  to  4  C.  c.  .    .    . 

0.50  to  2  C.  c.  .    . 

1  to  4  C.  c.  .  . 
4  to  16  C.  c.  .  . 
4  to  16  C.  c. 

4  to  16  C.  c.     .    . 

2  to  4  C.  c.  .  . 
2  to    4  C.  c.     ,    . 

1  to    5  milligrams 

2  to  16  C.  c.     .    . 

4  to  8  C.  c.  .  . 
2  to  15  C.  c.     .    . 

5  to  10  C.  c.  .  . 
I  to  2  C.  c.  ,  . 
I  to    4  C.  c.     .    . 

1  to  4  C.  c.  .  . 
o.6oto4C.c.     .    . 

5  C.  c 

5  C.  c.  .   .    .    .    . 

5  C.  c 

5  C.  c 

5  C.  c 

2  to  15  C.  c.    .   . 


Doses  in  apothecaries' 
weights  or  measures. 


2  to 

2  to 
8  to 
8  to 
I  to 
5  to 

3  to 
8  to 

15  to 


6T 


to 


5  to 

8  to 

8  to 

8  to 

8  to 

8  to 

5  to 

5  to 

8  to 

8  to 

5  to 

2  to 

5  to 

2  to 

I  to 

8  to 

30  to 

Xto 

8  to 

15  to 

S'to 

15  to 

I  to 

I  to 

I  to 

30  to 

30  to 

7?VtO 

K  to 
I  to 

yi.  to 

I  to 
15  to 
15  to 
15  to 
10  to 

I  fl. 

I  fl. 

I  fl. 

I  fl. 

ifl. 
Yz  to 


10  grams. 
30  grains. 
30  grains. 
60  grains. 
5  grains. 
30  grains. 
15  grains. 
60  grains. 
60  grains. 

TO  gi"aia- 
15  grains. 
30  grains. 
30  grains. 
30  grains. 
30  grains. 
30  grains. 
15  grains. 
30  grains. 
15  grains. 
30  grains. 
15  grains. 
15  grains. 
30  grains. 
10  grains. 

8  drachms. 
30  grains. 
60  minims. 
2  fl.  drachms. 
30  minims. 
60  minims. 
30  minims. 
60  minims. 
4  fl.  drachms. 
4  fl.  drachms. 
4  fl.  drachms. 
60  minims. 
60  minims. 
T2  grain. 

4  fl.  drachms. 

2  fl.  drachms. 

4  drachms. 

2  fl.  drachms. 
30  minims. 
60  minims. 
60  minims. 
60  minims, 
drachm, 
drachm, 
drachm, 
drachm, 
drachm. 
4  fl.  drachms. 


POSOLOGICAL  TABLES. 


Ill 


DOSE  TABLE  CONTINUED. 


Dose  in  metric  weights 

Doses  in  apothecaries' 

or  measures. 

weights  or  measures. 

Syrupus  lactucarii 

5  to  lO  C.  c 

I  to    3  fl.  drachms. 

Syrupus  pruni  virginiani  .    .    . 

4  to  16  C.  C 

I  to    4  fl.  drachms. 

Sympus  rhei 

4  to  15  C.  c 

I  to    4  fl.  drachms. 

Syrupus  rhei  arom 

4  to  1 5  C.  c 

I  to    4  fl.  drachms. 

Syrupus  rosfe 

4  to    8  C.  c 

I  to    2  fl.  drachms. 

Syrupus  rubi 

4  to    8  C.  c 

I  to    2  fl.  drachms. 

Syrupus  sarsap.  comp.     .    .    . 

4  to  15  C.  c 

1  to    4  fl.  drachms. 

Syrupus  sdWx 

2  to    4  C.  c 

_J^  to     I  fl.  drachm. 

Syrupus  scillfe  comp 

■  I  to    4  C.  c 

15  to  60  minims. 

Syrupus  senegce 

4  to    8  C.  c 

I  to    2  fl.  drachms. 

Syrupus  sennee 

5  to  15  C.  c 

I  to    4  fl.  drachms. 

Syrupus  tolutan 

4  to  32  C.  c 

I  to     8  fl.  drachms. 

Tinct.  aconiti  fol 

0.50  to  I  C.  c.    .    . 

Tinct.  aconiti  rad 

0.06  to  0.30  C.  c.  .    ,    , 

I  to    5  minims. 

Tinct.  aeon.  rad.  Fleming's    . 

0.04  to  0. 1 5  C.  c.   .    .    . 

y4,  to    2j4  minims. 

Tinct.  aloes(iS8o) 

2  to    8  C.  c 

^  to    2  fl.  drachms. 

Tinct.  aloes  et  mynhae    .    .    . 

4  to    8  C.  c 

I  to     2  fl.  drachms. 

Tinct.  arnicce  flor 

0.50  to  2  C.  c 

8  to  30  minims. 
15  to  30  minims. 

Tinct.  arnicae  rad 

I  to    2  C.  c 

Tinct.  asafetidce 

2  to    4  C.  c 

30  to  60  minims. 

Tinct.  belladonnce 

0  20  to  I  C  c 

3  to  15  minims. 
I  to    4  fl.  drachms. 

Tinct.  calumbffi 

3  to  15  C.  c 

Tinct.  cannabis  ind 

0.30  to  ''  C    c 

5  to  30  minims. 
I  to  10  minims. 

Tinct.  cantharid.  ...... 

0.06  to  0.60  C.  c.  .    .    . 

Tinct.  capsici 

0.30  to  2  C   c 

5  to  30  minims. 
^  to    2  fl.  drachms. 

Tinct.  catechu      

2  to    8  C.  c 

Tinct.  cimicifugae 

2  to    4  C.  c 

30  to  60  minims. 

Tinct.  cinchona; 

2  to    8  C.  c 

)4  to    2  fl.  drachms. 

Tinct.  cinchonse  comp.    .    .    . 

2  to    8  C.  c 

j^  to    2  fl.  drachms. 

Tinct.  colchicisem 

0.30  to  I  C   c 

5  to  15  minims. 
5  to  30  minims. 
1  to    2  fl.  drachms. 

Tinct.  conii 

0.30  to  2  C  c 

Tinct.  cubebse 

4  to    8  C.  c 

Tinct.  digitalis 

0.30  to  I  C  c 

6  to  15  minims. 
^  to    2  fl.  drachms. 

Tinct.  eucalypti 

3  to    8  C.  c 

Tinct.  ferri  chloridi 

I  to    2  C.  c 

15  to  30  minims. 

Tinct.  ferri  chloridi  aether  .    . 

I  to    2  C.  c 

15  to  30  minims. 

Tinct.  gentian  comp 

3  to    8  C.  c 

^  to    3  fl.  drachms. 

Tinct.  gelsemii 

0.50  to  I  C.  c 

8  to  15  minims. 
30  to  60  minims. 

Tinct.  guaiaci 

2  to    4  C.  c 

Tinct.  guaiaci  ammon.     .    ,    . 

2  to    4  C.  c 

30  to  60  minims. 

Tinct.  humuli 

4  to  lo  C.  c 

I  to    zyi  fl.  drachms. 

Tinct.  hydrastis 

2  to    6  C.  c 

30  to  90  minims. 

Tinct.  hyoscyami  fol 

I  to    4  C.  c.     ... 

15  to  60  minims. 

Tinct.  hyoscyami  sem.     .    .    . 

I  to    2  C.  c 

15  to  30  minims. 

Tinct.  iodi 

0.30  to  I  C  c 

5  to  15  minims. 
5  to  15  minims. 

Tinct.  ipecac,  et  opii   .... 

0.30  to  I  C.  c 

Tinct.  jalapae 

2  to    8  C.  c 

^  to    2  fl.  drachms. 

Tinct.  kino 

2  to    8  C.  c 

^  to    2  fl.  drachms. 

Tinct.  krameriaa 

2  to    8  C.  c 

^  to    2  fl.  drachms. 

Tinct.  lavend.  comp 

2  to    8  C.  c 

}4  to    2  fl.  drachms. 

Tinct.  lobelije 

I  to    3  C.  c 

15  to  45  minims. 

Tinct.  lupulini 

2  to    8  C.  c 1 

^  to    2  fl.  drachms. 

112 


DENTAL  MEDICINE. 


DOSE  TABLE  CONTINUED. 


Remedies. 


Dose  in  metric  weights 
or  measures. 


Dose  in  apothecaries' 
weights  or  measures. 


Tinct.  matico 

Tinct.  nuc   vomicse 

Tinct.  opii  deodorat 

Tinct.  opii  camph 

Tinct.  physostigmatis    .... 

Tinct.  pyrethri 

Tinct.  quassise 

Tinct.  rhei 

Tinct.  sanguinarise 

Tinct.  scillse 

Tinct.  serpentarise 

Tinct.  stramon.  fol 

Tinct.  stramon.  sem 

Tinct.  sumbul 

Tinct.  tolutan 

Tinct.  valer 

Tinct.  valer.  amon 

Tinct.  veratr.  vir 

Tinct.  zingiberis 

Tritur.  elaterini 

Uva  ursi 

Veratrini 

Vin.  aloes 

-rr-  ^.        f  expect,    et.    alt 

Vin.  antim.  -i        ^  ^ 

(  emet 

Vin.  colch.  rad 

Vin.  colch.  sem 

Vin.  ergotse 

Vin.  ferri  amar 

Vin.  ferri  citrat 

Vin.  xericum 

Vin.  ipecac.  <    '  "  ^ 

^  (  emet 

Vin.  opii 

Vin.  portense 

Vin.  rhei 

Zinci  acet 

Zinci  oxid 

Zinci  sulphas  emet 

Zinci  valerianas 


2  to  8  C.c 

o.o6  to  o.6o  C.  c.  . 
0.30  to  2  C.  c.  .  .  . 
0.50  to  5  C.  c.  .  .  . 
0.30  to  I  C.  c.  .  .  . 
0.50  to  2  C.  c.  .   .    . 

2  to  8  C.  c 

4  to  30  C.  c 

1  to  4  C,  c.  .  ,  • .  . 
0.50  to  4  C.  c.  .    .    . 

2  to  8  C.  c 

0.50  to  I  C.  c.  .  .  . 
0.30  to  I  C.  c.  .  .  . 
0.50  to  2  C.  c.  .   .    . 

4  to  8  C.  c 

2  to  8  C.  c 

2  to  8  C.  c 

0.20  to  0.60  C.  c.     . 

1  to  4  C.  c 

8  to  30  milligrams    . 

2  to  4  Gm 

1  to  6  milligrams  .    . 

4  to  8  C.  c 

0.06  to  0.50  C.  c.     . 

2  to  5  C.  c 

0.30  to  2  C.  c.  .  .  . 
0.30  to  2  C.  c.  .    .    . 

4  to  12  C.  c 

5  C.  c 

5  C.  c 

4  to  32  C.  c 

0.30  to  I  C.  c.  .  .  . 
10  to  25  C.  c.  .  .  . 
0.30  to  I  C.  c.  .  .  . 
4  to  32  C.  c 

4  to  8  C.  c 

5  to  12  centigrams    . 

6  to  60  centigrams    . 

I  to  2  Gm 

30  to  120  milligrams 


^  to  2  fl.  drachms. 
I  to  10  minims. 
5  to  30  minims. 
8  to  75  minims. 

5  to  15  minims. 
8  to  30  minims. 

^  to  2  fl.  drachms, 
I  to  8  fl.  drachms. 
15  to  60  minims. 
8  to  60  minims. 
J^  to  2  fl.  drachms. 
8  to  15  minims. 

6  to  15  minims. 
8  to  30  minims. 

I  to  2  fl.  drachms. 
^  to  2  fl.  drachms. 
^  to  2  fl.  drachms. 
3  to  10  minims. 
15  to  60  minims, 
^  to  }4  grain. 
^  to  I  drachm. 
6?  to  xV  grain. 
I  to  2  fl.  drachms, 
I  to  8  minims. 
30  to  75  minims. 
5  to  30  minims. 
5  to  30  minims. 
I  to  3  fl.  drachms. 
I  fl.  drachm. 
I  fl.  drachm. 
I  to  8  fl.  drachms. 
5  to  15  minims. 
3  to  6  fl.  drachms, 
5  to  15  minims. 
I  to  8  fl.  drachms. 
I  to  2  fl.  drachms. 
I  to  2  grains. 
I  to  10  grains. 
15  to  30  grains. 
11^  to  2  grains. 


The  Best  Twenty-five  Drugs. — -It  is  claimed  that  the 
medical  art  could  be  carried  on  with  the  following  drugs, 
twenty-five  in  number,  and  which  represent  the  soul  of  the 
Pharmacopoeia:  i,  opium;  2,  mercury;  3,  iodides;  4,  quinine; 
5,  chloroform;  6,  ether;  7,  sulphate  of  magnesia;  8,  salicylic 
acid;    9,  aloes;     10,     alcohol;    11,  bromides;    12,  iron;     13, 


POISONS.  113 


chloral;  14,  castor  oil ;  15,  digitalis;  16,  arsenic;  17,  colchi- 
cum;  18,  ipecac;  19,  aconite;  20,  strychnia ;  21,  cocaine;  22, 
ergot;  23,  bicarbonate  of  potash;  24,  mineral  acids;  25, 
nitrites. 

POISONS. 

SYMPTOMS   AND   ANTIDOTES 

Cases  of  poisoning  require  the  prompt  administration  of 
remedies,  and  hence  a  knowledge  of  the  usual  antidotes  is 
requisite,  in  order  that  they  may  be  employed  with  effect. 

P'or  the  majority  of  such  cases  the  chief  reliance  must  be 
upon  emetics,  so  that  free  vomiting  may  be  induced  by  such 
articles  of  this  class  which  are  most  speedy  in  their  effect. 
Sulphate  of  zinc  is  preferable  to  many,  and,  if  vomiting  is 
present,  it  may  be  aided  by  diluents  or  a  vegetable  emetic. 
When  the  poisonous  substance  has  remained  for  any  length  of 
time  in  the  stomach,  the  use  of  emetics  will  not  prove  suffi- 
cient, but  resort  must  be  had  to  the  stomach-tube  and  syringe. 
Milk,  lime  water,  soap,  or  solutions  of  sugar  or  honey  will 
protect  the  stomach  and  intestines,  while  oil  and  other  fatty 
matters  may  prove  injurious.  Carbonate  of  magnesia  with 
tincture  of  opium,  suspended  in  water,  freely  administered, 
will  prove  very  serviceable  after  the  vomiting  has  ceased,  and 
the  patient  is  suffering  from  retching  and  pain. 

When  the  nature  of  the  poison  is  unknown,  a  general  anti- 
dote, consisting  of  equal  parts  of  calcined  magnesia,  pulverized 
charcoal,  and  hydrated  peroxide  of  iron,  which  are  to  be 
diffused  in  water,  may  be  freely  administered,  and  will,  in  the 
"majority  of  cases,  prove  efficient,  as  one  or  another  of  them  is 
an  antidote  to  most  of  the  mineral  poisons. 

The  albumen  of  eggs  and  tannic  acid  are  also  considered 
to  be  valuable  antidotes.  The  albumen  neutralizes  corrosive 
sublimate  and  like  salts,  and  the  tannic  acid  precipitates  all  of 
the  vegetable  alkaloids  as  tannates. 

ACIDS  {Mineral). 

Symptoms. — Corrosion  of  parts  with  which  the  acid  comes 
in   contact,  with  an  immediate  burning  pain  in   the   mouth, 


114  DENTAL  MEDICINE. 


throat,  oesophagus  and  stomach ;  vomiting  of  liquid  impreg- 
nated with  mucus  and  blood.  Death  occurs  from  inflamma- 
tion, or  from  asphyxia. 

Antidotes. — Chalk;  magnesia  ;  solution  of  carbonate  of  soda; 
emollient  drinks ;  fixed  oil  and  fatty  matter;  plaster  off  wall, 
in  emergency. 

ACONITE. 

Symptoms. — Numbness  and  tingling  of  the  mouth  and  throat, 
followed  by  vomiting  and  purging;  giddiness  ;  feeble  pulse  ; 
dilated  pupil;  oppressive  breathing ;  paralysis.  Death  occurs 
from  syncope  or  apnoea. 

Antidotes. — Emetics  ;  stimulants,  external  and  internal,  such 
as  sulphate  of  zinc,  tannic  acid,  animal  charcoal,  atropine, 
belladonna. 

ALKALIES  {See  Potash). 
ANTIMONY  {Tartar  Emetic,  Butter  of  Antimony). 

Symptoms. — A  burning  pain  in  stomach  and  bowels ;  vomit- 
ing; purging;  cold  perspiration ;  great  thirst;  cramps;  great 
debility,  and  death. 

Antidotes. — Vegetable  acids,  such  as  tannic  acid,  catechu, 
nutgalls,  white  oak  bark,  kino,  cinchona. 

ARSENIC. 

Symptoms. — Faintness  and  nausea,  with  burning  pain  in  the 
epigastrium;  vomiting;  purging,  or  diarrhoea;  thirst;  con- 
striction in  the  throat;  feeble  action  of  the  heart,  with  a  quick 
and  weak  pulse ;  painful  and  hurried  respiration ;  cold  and 
clammy  skin.  Death  occurs  from  collapse,  and  sometimes 
with  convulsions. 

Antidotes. — Freshly  precipitated  hydrated  sesquioxide  of 
iron  (made  by  adding  magnesia  to  any  iron  solution);  animal 
charcoal;  ammonia;  lime  water ;  stomach-pump;  artificial 
.respiration  ;  cold  affusion  ;  emetics ;  milk  ;  raw  eggs. 

ARGENTI  NITRAS  {Nitrate  of  Silver). 

Symptoms. — Corrosion  of  parts ;  sometimes  nausea  and 
vomiting  and  convulsions ;  paralysis. 

Antidotes. — Solution  of  common  salt  in  demulcent  drinks; 
albumen. 


POISONS.  115 


ATROPINE. 

Symptoms. — Insatiable  thirst,  with  dryness  of  mouth  and 
throat;  nausea;  giddiness;  palpitation  of  heart;  intensely  di- 
lated pupil,  coma  and  death. 

Antidotes. — Emetics ;  sulphate  of  copper  (gr.  x) ;  cold  to 
head;  ammonia,  externally  and  internally;  opium;  animal 
charcoal;  calabar  bean;  stimulants;  subcutaneous  injection  of 
morphia  ;  mustard  flour  in  water;  cold  to  head. 

BELLADONNA. 

Symptoms. — Same  as  those  of  atropine. 
Antidotes. — Same  as  for  atropine. 

CANNABIS  INDICA  {Indian  Hemp). 

Symptoms. — Temporary  insanity,  as  shown  by  a  singular  gait, 
a  constant  rubbing  of  hands,  and  other  strange  actions,  a 
peculiar  and  cunning  appearance  of  the  eyes,  great  hunger. 

Antidotes. — Hot  brandy  and  water;  vegetable  acids,  such  as 
lemon-juice,  vinegar,  etc. ;  blisters  to  nape  of  neck  ;  indulgence 
in  sleep. 

CANTHARIDES. 

Symptoms. — A  burning  pain  in  stomach ;  vomiting  and 
purging ;  blood-stained  urine ;  pain  in  loins,  strangury ;  pria- 
pism; convulsions;   death. 

Antidotes. — Emetics;  emollient  or  mucilaginous  drinks; 
opiates  by  mouth  and  rectum;  venesection,  if  necessary, 

CARBOLIC  ACID. 

Symptoms. — When  taken  internally,  it  causes  pain  in  the 
stomach;  a  whitened  and  shriveled  appearance  of  the  mucous 
membrane  of  the  lips,  mouth  and  throat ;  sometimes  vomit- 
ing; contracted  pupils  ;  stertorous  breathing ;  coma,  and  death 
within  a  period  of  from  five  to  ten'  minutes  to  eight  or  ten 
hours,  according  to  the  quantity  of  the  acid  swallowed. 

Antidotes. — Olive  oil;  castor  oil  ;  lime  water;  saccharate  of 
lime;  precipitated  carbonate  of  lime ;  albuminous  and  mucila- 
ginous substances ;  any  soluble  sulphate  such  as  magnesia. 


116  DENTAL  MEDICINE. 


CHLORINE  WATER. 

Syjnptoms. — Irritation  of  air  passages;  burning  pain  in  the 
throat  and  stomach;  vomiting  of  bloody  mucus. 
Antidotes. — Albumen;  white  of  egg;  milk;  flour. 

CHLORAL. 

Symptoms. — Excitement ;  delirium  ;  flushed  face ;  cramps 
in  limbs ;  eyes  closed ;  profound  unconsciousness  ;  stertorous 
breathing;  increasing  feebleness ;  lividity  of  countenance ;  loss 
of  pulse ;  pallor ;  coldness  of  extremities ;  muscular  relaxa- 
tion; death  from  cardiac  syncope. 

Antidotes. — Nitrite  of  amyl,  when  the  poison  has  been  taken 
in  large  quantity ;  strychnia,  when  the  action  of  the  poison  is 
slow  and  culminative.  According  to  some  authorities,  picro- 
tine,  ^5  gr.,  sufficient  for  30  grs.  of  chloral ;  coffee. 

CHLOROFORM. 

Symptoms.  —  Drowsiness;  insensibility;  stertorous,  rapid 
breathing ;  weak  pulse ;  dilatation  of  pupils ;  relaxation  of 
muscles;  coldness  of  surface;  increasing  feebleness  of  pulse; 
heart  ceasing  its  action. 

Antidotes. — Fresh  air;  artificial  respiration  (inclining  head 
down,  tongue  pulled  forward),  cold  water  dashed  over  face  and 
chest;  galvanism  to  pneumogastric  and  through  diaphragm 
(one  pole  may  be  applied  to  nape  of  neck  and  the  other  to  the 
pit  of  the  stomach) ;  brandy  and  ammonia  enemata ;  hypo- 
dermic injection  of  15  1TL  of  tincture  of  digitalis,  and  eV  gr.  of 
atropine,  or  hypodermic  injection  of  i  drachm  of  ether;  in- 
halation of  nitrite  of  amyl ;    tracheotomy. 

CONIUM   {He^nlock). 

Symptoms. — Thirst ;  dryness  of  throat ;  delirium ;  convul- 
sions ;  coma  and  death,  resulting  from  paralysis  of  the  respira- 
tory muscles. 

Antidotes. — Emetics,  followed  by  demulcent  drinks,  internal 
and  external  stimulants,  as  brandy ;  ammonia;  coffee,  if  coma 
is  present;  tannic  acid;  animal  charcoal. 


POISONS.  117 

CORROSIVE   SUBLIMATE. 

Symptoms. — Heat  and  pain  of  a  burning  nature  in  mouth, 
and  throat,  and  stomach  ;  nausea ;  vomiting  of  bloody  mucus  ; 
diarrhoea ;  dysentery ;  cramps  ;  convulsions  ;  coma  and  death. 

Antidotes. — Albumen;  milk;  white  of  egg  (white  of  i  ^g^ 
to  every  4  grs.  of  corrosive  sublimate  taken);  flour;  per- 
chloride  of  tin ;  iron  and  zinc  (iron  filings  2  parts  and  zinc 
I  part) ;  emetics,  stomach-pump. 

CREASOTE  {See  Carbolic  Acid). 
CROTON    OIL. 

Symptoms. — Irritation  of  mucous  membrane  ;  burning  pain 
along  course  of  alimentary  tract ;  excessive  purging ;  inflam- 
mation of  stomach  and  intestines. 

Antidotes. — Emetic  of  sulphate  of  copper,  10  grs.,  followed 
by  mucilaginous  fluids  containing  opium,  to  allay  the  pain ; 

olive  oil ;  opium. 

SULPHATE   OF    COPPER. 

Symptoms. — Metallic  taste ;  eructations ;  violent  emesis  and 
purging ;  cramps  in  limbs ;  griping  pains ;  headache ;  giddi- 
ness ;  convulsions ;  coma  and  death,  with  symptoms  of  a  dis- 
ordered condition  of  the  nervous  system. 

Antidotes. — Albumen  or  white  of  &^^ ;  yellow  prussiate  of 
potash,  or  soap. 

DIGITALIS. 

Symptoms. — Nausea ;  vomiting ;  purging ;  feeble  or  slow 
and  irregular  pulse;  dilated  pupils;  excessive  debility;  stupor; 
convulsions  ;    coma  and  death. 

Antidotes. — Recumbent  posture  after  the  use  of  such  emetics 
as  sulphate  of  zinc;  stimulate  internally  and  externally;  tannic 
acid;  animal  charcoal;  tincture  of  aconite. 

HYDROCYANIC    ACID. 

Symptoms. — Dilated  pupils ;  spasmodic  breathing;  convul- 
sions ;  insensibility ;  fixed  eyes  ;  spasmodic  closure  of  jaws  ; 
very  feeble  pulse  and  speedy  death. 


118  DENTAL  MEDICINE, 


Antidotes. — Fresh  air  and  artificial  respiration,  with  cold 
affusion  upon  head  and  neck-;  freshly  precipitated  oxide  of 
iron,  with  an  alkaline  carbonate,  such  as  carbonate  of  am- 
monia; chlorine;  ammonia  by  inhalation  and  injection  in 
vein  of  leg, 

HYOSCYAMUS, 

Symptoms. — A  feeling  of  giddiness,  followed  by  delirium ; 
dilated  pupils ;  fullness  about  the  head ;  drowsiness ;  cold 
perspiration ;  paralysis  ;  exhaustion ;   death. 

Antidotes. — Stomach  pump ;  emetics ;  stimulants,  external 
and  internal ;  lemon  juice;  strong  coffee, 

IODINE, 

Symptoms. — In  extreme  cases,  violent  vomiting  and  purg- 
ing ;  fever  and  excessive  thirst ;  palpitation  of  heart ;  cramps  ; 
small  and  frequent  pulse ;  occasional  dry  cough ;  and  when 
death  ensues,  it  is  probably  due  to  gastro-enteritis.  In  exces- 
sive doses,  it  acts  as  an  irritant  poison,  giving  rise  to  such 
symptoms  as  restlessness ;  burning  sensation ;  palpitation ; 
violent  priapism  ;  frequent  pulse  ;  excessive  thirst ;  extreme 
diarrhoea;  trembling;  extreme  emaciation,  and  sometimes 
syncope. 

Antidotes. — Emetics  and  demulcent  drinks  ;  starch  or  flour 
diffused  in  water  ;  albumen ;  milk ;  opium  and  external  heat, 

LEAD    SALTS. 

Symptoms. — A  dry  and  constricted  throat ;  pain  in  stomach 
and  bowels ;  colic  ;  paralysis  of  extensor  muscles ;  apoplectic 
symptoms. 

Antidotes. — Any  soluble  sulphate,  either  magnesia  or  soda ; 
Epsom  salts,  followed  by  emetics,  and  afterwards  opium  and 
milk;  iodide  of  potassium. 

MORPHINE  {See  Opium). 
MERCURY. 

When  in  the  form  of  the  bichloride  (corrosive  sublimate), 
or  nitrate  of  mercury,  see  corrosive  sublimate. 


POISONS.  119 

NUX   VOMICA. 

Symptoms. — Spasmodic  twitching  of  muscles  ;  violent  move- 
ment of  limbs  ;  tetanic  spasms  ;  dyspnoea  ;  death. 

Antidotes. — Thirty  grains  of  chloral  and  60  grains  of  bromide 
of  potassium.     Nitrite  of  amyl. 

OPIUM. 

Symptonis. — Increasing  drowsiness  ;  giddiness  ;  stupor ;  in- 
sensibility; stertorous  breathing;  feeble  pulse;  contracted 
pupil;  coma;  convulsions;  death. 

Antidotes. — Emetic  of  10  grs.  of  sulphate  of  copper ;  stomach 
pump  ;    stimulants,  external  and  internal  ;    brandy  and  coffee  ; 
artificial  respiration  ;   cold  affusion  ;   ammonia  to  nostrils  ;  en- 
forced exertion  ;  galvanic  shocks  ;  belladonna  ;  tannic  acid  ;  • 
animal  charcoal ;  atropine  hypodermically. 

OXALIC    ACID. 

vS)/;;//^*?;;^.— Burning  pain  in  throat,  oesophagus  and  stom- 
ach; vomiting  of  a  dark  green  or  black  fluid,  composed  of 
altered  mucus  and  blood. 

Antidotes. — Chalk;  magnesia;  plaster  from  wall  in  emer- 
gency; lime,  not  potash  or  soda;  emetics;  stomach  pump. 

PHOSPHORUS. 

Symptoms. — Burning  pain  along  alimentary  tract ;  corrosion 
of  tissues  ;  vomiting  of  mucus  and  blood ;  diarrhoea. 
Antidotes. — Sulphate  of  copper;  emetics  and  purgatives. 

POTASH  AND  SODA  SALTS. 

Symptoms. — Sharp,  burning  pain  of  the  mouth,  throat, 
oesophagus  and  stomach ;  corrosion ;  vomiting  of  blood  and 
mucus. 

Antidotes. — Dilute  acetic  acid ;  citric  acid ;  lemon  juice  ;  fixed 
oils  ;  demulcents ;  vinegar. 

SILVER  {Nitrate  of  Silver). 

Symptoms. — Corrosion  of  tissues;  nausea;  vomiting;  con- 
vulsions ;  paralysis. 


120  DENTAL   MEDICINE. 


Antidotes. — Chloride  of  sodium  (common  salt) ;  albumen ; 
white  of  ^%%. 

STRAMONIUM  {See  Belladonna). 
STRYCHNINE. 

Symptoms. — Spasmodic  action  of  muscles  (twitching) ;  jerk- 
ing of  limbs  ;  tetanic  spasms  ;  dyspnoea ;  death. 

Antidotes. — Chloroform;  belladonna;  tincture  of  aconite; 
morphine  ;  8  grs.  morphine  antidote  to  i  gr.  strychnia ;  extract 
of  conium  ;  also  same  as  nux  vomica. 

TOBACCO. 

Symptoms. — Nausea;  vomiting;   violent  retching. 
Antidotes. — Emetic ;  stimulants,  both  external  and  internal ; 
strychnia ;  external  heat. 

ZINC   SALTS. 

Symptoms. — A  burning  sensation  in  stomach ;  nausea ; 
vomiting;  anxious  countenance;  difficult  breathing;  small, 
quick  pulse  ;  cold  perspiration  ;  syncope;  convulsions;  death. 

Antidotes. — Carbonate  of  soda  ;  emetics  ;  warm  demulcent 

drinks. 

THE   PULSE. 

The  word  "  pulse  "  is  derived  from  the  Latin  word  pidso,  "I 
strike,"  and  denotes  the  striking  or  hfting  of  the  finger  by  the 
distending  vessel,  as  with  each  contraction  of  the  heart  blood 
is  forced  into  the  vessels. 

The  word  pulse  has  also  been  applied  to  the  appearance  of 
a  lifting  up  of  the  coverings  over  a  distending  vessel,  so  that 
this  word  "pulse  "  is  applied  not  only  to  that  which  is  felt, 
but  to  that  which  is  seen. 

There  are  two  kinds  of  pulse,  the  arterial  and  the  venous. 
The  arterial  is  appreciated  mainly  by  palpitation,  the  venous 
by  inspection.  It  is  the  "  arterial  pulse  "  that  it  is  necessary  to 
study. 

The  "  radial  pulse  "  is  the  one  usually  selected,  although  the 
"  temporal  pulse  "  is  also  noted  in  the  administration  of  anaes- 
thetic agents.     The  pulse  in  other  vessels  must  also  some- 


THE   PULSE.  121 


times  be  observed,  as  in  the  brachial,  the  facial  in  front  of  the 
masseter  muscle,  the  posterior  tibial,  the  dorsalis  pedis,  the 
carotid  and  femoral  arteries. 

The  "  radial  pulse,"  the  one  usually  selected,  and  which,  in 
most  cases,  answers  all  the  requirements,  is  of  moderate  size, 
superficial,  and  can  be  readily  compressed  against  the  radius. 

When  the  pulse  is  to  be  observed,  the  patient  should  be 
either  sitting  or  lying  down.  The  observer  should  place  his 
index,  middle,  or  ring  finger  lightly  upon  the  pulse,  and  should 
then  appreciate  the  state  of  the  coats  of  the  artery,  and  should 
next  note  the  frequency,  the  rhythm,  the  tension,  volume  and 
force  of  the  pulse ;  and,  lastly,  any  peculiarities,  if  present. 
Moreover,  the  pulse  of  one  side  of  the  body  should  always 
be  compared  with  the  other. 

It  should  also  be  remembered  that  forcible  extension  or 
flexion  of  the  forearm  will  sometimes  arrest  the  radial 
pulse. 

In  noting  the  pulse  of  children  and  infants,  it  is  well  to 
count  the  pulse,  if  possible,  while  they  are  asleep. 

This  can  be  conveniently  done  in  the  temporal  artery. 

In  noting  the  pulse  of  the  wrist,  asleep  or  awake,  there  are 
often  involuntary  movements  of  the  arm  and  twitching  of  the 
muscles,  which  render  it  difficult  to  keep  the  finger  of  the 
observer  on  the  pulse.  This  difficulty  may  be  overcome  in  a 
great  degree  by  grasping  the  entire  hand  of  the  child,  and  then 
extending  the  index  finger  upon  the  pulse.  It  is  also  advis- 
able not  to  take  the  pulse  of  the  patient  until  some  little  time 
has  elapsed  after  the  appearance  of  the  observer.  In  health, 
changes  in  the  frequency  and  rhythm  of  the  pulse  are  often 
met  with. 

The  following  is  a  table  of  the  variations  in  the  frequency  of 
the  pulse  in  health  : — 

Infant  asleep,  at  birth 140 

Infancy 120 

Child  under  5  years  of  age 100 

Youth 90 

Male  adults 72-So 

Female  adults 80-85 

Old  age 70 


122  DENTAL  MEDICINE. 


It  is  only  in  rare  cases  that  great  frequency  of  the  pulse  in 
health  is  met  with.  Sex  has  some  influence.  Up  to  the  7th 
year  of  age  the  frequency  is  about  the  same  in  both  sexes, 
but  later  the  female  is  from  6  to  14  beats — average  9 — greater 
than  in  the  male. 

Posture  also  affects  the  pulse.  It  is  most  frequent  in  the 
standing,  and  least  in  the  recumbent  position. 

The  pulse  of  a  man  is  twice  as  much  affected  by  change  of 
position  as  that  of  a  woman. 

When  the  pulse  is  much  increased  in  frequency,  change  in 
position  has  but  little  effect,  and  for  the  higher  numbers 
entirely  disappears.  When  the  head  is  lower  than  the  body, 
the  pulse  falls.  The  general  law  as  to  the  degree  of  frequency 
of  the  pulse,  as  affected  by  position,  is  as  follows  : — 

The  frequency  is  directly  proportionate  to  the  amount  of 
muscular  effort  required  to  support  the  body  in  different  posi- 
tions. The  pulse  falls  in  sleep,  as  much  as  ten  beats.  Sleep- 
lessness increases  its  frequency.  On  awakening  from  sleep, 
there  is  usually  a  decided  increase  in  frequency.  Food  in- 
creases the  rate  of  the  pulse.  Mental  excitement  and  activity 
of  the  emotions  increases  the  frequency ;  mental  depression  is 
often  accompanied  by  a  decrease.  Cold  lowers  and  heat  raises 
the  rate  of  the  pulse.  Among  other  causes  producing  an 
increase  in  the  frequency  of  the  pulse  in  health,  are  spirituous 
and  warm  drinks,  tobacco,  diminished  atmospheric  pressure. 
Among  other  causes  producing  diminished  frequency  of  the 
pulse,  besides  those  before  mentioned,  are  fatigue,  long-con- 
tinued rest,  debility  without  disease,  and  increased  atmos- 
pheric pressure. 

Occasionally  the  pulse  is  irregular  in  health,  but  when  it  is 
so,  it  is  usually  congenital.  Intermittency  is  not  infrequent 
in  health,  and  it  is  then  either  congenital  or  may  be  due  to 
terror,  anxiety,  grief,  mental  or  physical  fatigue,  and  old  age. 
The  intermittency  may  be  only  temporary,  or  it  may  become 
permanent ;  and  if  it  becomes  very  frequent,  may  be  patho- 
logical. 

A  pulse  of  90  or  more  may  be  regarded  as  a  pulse  of  abnor- 


THERMOMETERS.  123 


mal  frequency  in  an  adult.  There  are  exceptions  to  this,  but 
they  are  rare.  If  the  pulse  is  quicker  than  the  temperature 
will  explain,  it  indicates  cardiac  weakness. 

A  pulse  that  day  by  day  progressively  increases,  the  tem- 
perature remaining  the  same,  shows  increased  cardiac  weak- 
ness. In  all  febrile  diseases,  a  pulse,  in  adults,  over  120  is 
serious,  and  indicates  cardiac  weakness.  A  pulse  of  130  or 
140  indicates  great  danger;  and  with  a  pulse  at  160,  the 
patient  almost  always  dies. 

Under  the  age  of  fifteen,  any  disease  of  the  lungs  is 
almost  invariably  accompanied  by  great  frequency  of  the 
pulse,  so  that  a  pulse  of  120  to  140  would  not  be  con- 
sidered as  so  serious  in  significance  as  if  it  occurred  in  an 
older  person. 

A  pulse  of  120  in  a  strong,  robust  patient  affected  with 
pneumonia,  indicates  some  form  of  heart  disease.  When  pneu- 
monia occurs  in  the  cachectic  or  debilitated,  the  pulse  is 
usually  very  frequent,  often  120  to  160,  and  such  cases  usually 
die.  In  pericarditis  and  myocarditis,  there  is  great  frequency 
of  the  pulse,  especially  on  any  movement  of  the  patient — 130 
to  160 — and  the  change  may  be  very  sudden.  In  acute 
articular  rheumatism,  unaccompanied  by  any  heart  disease, 
a  pulse  of  120  or  more  indicates  great  danger.  In  pleuritic 
effusions,  the  pulse  may  be  very  frequent,  especially  when 
there  is  displacement  of  the  heart. 

■  RESPIRATION  AT  VARIOUS  STAGES. 

At  one  year  of  age,  per  minnte 35 

"  two  years  of  age,  "         "      . 25 

"  puberty,  "         "      20 

"  adult  age,  "         " 18 

THERMOMETERS. 
There  are  three  different  thermometers  in  use — Fahren- 
heit's, Centigrade  and  Reaumur's — each  differing  from  the 
other  with  reference  to  the  number  of  degrees  between  the 
freezing  and  boiling  points  of  water.  In  Fahrenheit's,  zero  is 
placed  at  32  degrees  below  the  freezing  point,  while  in  the 
others  zero  marks  the  freezing  point. 


124  DENTAL   MEDICINE. 


32 

77 

122 

167 

212 

0 

25 

50 

75 

100 

0 

20 

40 

60 

80 

The  boiling  point  in  Fahrenheit's  is  placed  at  212  degrees; 
in  Centigrade  at  100,  and  in  Reaumur's  at  80. 

The  degrees  between  the  freezing  and  boiling  points  in  the 
instruments  are,  therefore,  respectively  180,   100  and  80. 

The  following  diagram  will  explain  the  variance : — 

Fahrenheit o. 

Centigrade 17-77 

Reaumur 14.22 

When  a  thermometer,  in  the  process  of  vulcanizing,  gives 
trouble  by  the  column  of  mercury  becoming  divided,  the  di- 
vided portion  remaining  in  the  top  of  the  tube,  the  best  method 
is  to  unscrew  the  thermometer  and  turn  it  upside  down,  and 
make  the  mercury  in  the  bulb  unite  with  the  mercury  in  the 
tube,  so  that  it  may  coalesce  perfectly.  This  is  a  better 
method  than  striking  the  thermometer  sharply  in  the  hollow 
of  the  left  hand,  and  thereby  risking  the  breaking  of  the  thin 
glass  tube. 

The  Clinical  Thermometer  is  employed  as  a  valuable  means 
of  diagnosis  and  prognosis.  It  is  valued  because  the  vital 
processes  can  only  be  normally  and  perfectly  performed  at 
the  temperature  of  983^°,  and  just  in  proportion  as  it  varies 
from  this,  either  above  or  below,  they  are  changed  or  entirely 
arrested.  This  standard  of  temperature,  98^°,  of  the  healthy 
body,  is  subject  to  slight  variations  during  the  day.  Although 
observations  show  that  the  normal  heat,  which  is  the  most 
essential  condition  of  life,  may  be  considerably  altered  by  a 
number  of  circumstances,  yet  the  variations  in  health  are 
generally  temporary  and  within  narrow  limits,  whereas  those 
which  arise  from  disease  are  persistent  during  the  continuance 
of  the  abnormal  condition.  Both  increase  and  decrease  of 
temperature  have  to  be  considered,  for  while  an  increase  of 
four  to  six  degrees  may  be  maintained  for  a  month,  and  not 
endanger  life,  a  decrease  of  but  one  degree,  if  maintained  for 
a  considerable  time,  will  result  in  death.  The  increase  in 
temperature  of  the  body  is  usually  proportionate  to  the  fre- 
quency of  the  pulse,  one  degree  corresponding  to  an  increase 
of  ten  beats  per  minute.     Thus — 


THERMOMETERS. 


125 


With  a  temperature  of    98°,  we  have  a  pulsation  of  60. 

"                 "                   99°           "               "  70. 

"                 "                 100°           "              "  80. 

"                 "                 101°           "               "  90. 

"                 "                 102°           «               "  100. 

u                 «                  1030           «               "  110. 

"                 "                  104°           "              "  120. 

TABLE  OF  ELEMENTARY  SUBSTANCES. 


Aluminum 
Antimony 
Arsenic  . 
Barium  . 
Berylium  . 

(Glucinum.) 
Bismuth  . 
Boron  .  . 
Bromine  . 
Cadmium 
Csesium  . 
Calcium  . 
Carbon  '  . 
Cerium  . 
Chlorine^ 
Chromium 
Cobalt  .  , 
Copper  . 
Didymium 
Erbium  . 
Fluorine  . 
Gallium  . 
Gold  .  . 
Hydrogen 
Indium  . 
Iodine  ,  . 
Iridium  . 
Iron  .  . 
Lanthanum 
Lead  .  . 
Lithium  . 
Magnesium 
Manganese 
Mercury  , 


^ 

.a 

Atomic 

Equiva- 

S 
in 

Weight. 

lent. 

Al 

27 

13.5 

Sb 

120 

120 

As 

75 

75 

Ba 

137 

68.4 

Be 

9 

9 

Bi 

28 

28 

B 

II 

II 

Br 

79.95 

79.95 

Cd 

III. 8 

55-9 

Cs 

132.6 

132.6 

Ca 

40 

20 

C 

12 

6 

Ce 

140.2 

70.5 

CI 

35-45 

35-45 

Cr 

52.1 

26.2 

Co 

58.q 

29.45 

Cu 

63.4 

31.6 

Di 

144.6 

72.3 

E 

165.9 

82.95 

bl 

19 

^9 

G 

68.8 

34.4 

Au 

197.3 

197.3 

H 

1.007 

1.007 

In 

"3-4 

56.7 

I 

126.85 

126.85 

Ir 

192.7 

96.35 

l-'e 

56 

27.95 

La 

i3«.5 

138.5 

Bb 

206.95 

103.25 

Li 

7.02 

7.02 

Mg 

24.3 

12 

Mn 

55 

27 

Hg 

200 

99.85 

Elements. 


Molybdenum 
Nickel  . 
Niobium  . 
Nitrogen  * 
Osmium  . 
Oxygen  * . 
Palladium 
Phosphorus 
Platinum  . 
Potassium 
Rhodium 
Rubidium 
Ruthenium 
Scandium 
Selenium . 
Silicon 
Silver  .  . 
Sodium  . 
Strontium 
Sulphur  * . 
Tantalum 
Tellurium 
Thallium 
Thorium  . 
Tin  .  .  . 
Titanium . 
Tungsten 
Uranium  , 
Vanadium 
Ytterbium 
Yttrium  . 
Zinc ,  .  . 
Zirconium 


_• 

Xi 

Atomic 

E 

Weight. 

in 

Mo 

95-5 

Ni 

58 

Nb 

94 

N 

14-03 

Os 

198.5 

0 

16 

Pd 

105.7 

P 

31 

Pt 

194.4 

K 

39-" 

Rh 

104. 1 

Rb 

85.3 

Ru 

104.2 

Sc 

44 

Se 

78.8 

Si 

28.4 

Ag 

107.92 

Na 

23-05 

Sr 

87.4 

S 

32.06 

la 

182 

Te 

128 

Tl 

203.7 

Th 

233 

Sn 

117.7 

Ti 

48 

Tr 

183-6 

U 

238.5 

V 

51.3 

Yb 

172.7 

Y 

89.8 

Zn 

65-3 

Zr 

90 

Equiva- 
lent. 


42.75 
29 

94 
14 

99.25 
8 

52.85 
31 

97.2 

39-11 
52.05 

85-3 
52-1 
22 
39-4 
14 
107.92 

23-05 

43-7 

16 
182 

64 
203.7 
116.5 

58.85 

24 

91.8 
119.25 

51-3 
172.7 
89.8 
32-45 
45 


iCarbon:  1119736.     ^chlorine;  35.370.    ^ Nitrogen  :  14.021.     ^Oxygen:  15.9633.     ^Sulphur: 
31.984. 


126 


DENTAL   MEDICINE. 


Table  of  the  Soi-ubility  of  Chemicals  in  Water  and  Alcohol. 

=  insoluble  ;  sp.  =  sparingly  ; 
almost;  dec.  =  decomposed. 


Abbreviations { ^;  =  "^'J^"^!^^!^""-  =.i"s°'i>Me;  sp.  =  sparingly; 


CHEM-ICALS. 


One  part  is  soluble  in : 

Acidum  arseniosum 

Acidum  benzoicum 

Acidum  boricum       

Acidum  carbolicum 

Acidum  cliromicuin 

Acidum  citricum 

Acidum  gallicum 

Acidum  salicylicum 

Acidum  tannicum 

Acidum  tartaricum 

Alumen 

Alumen  exsiccatum 

Ammonii  carbonas  ... 

Ammonii  nitras 

Ammonii  valerianas 

Antimonii  et  potassii  tartras.  . 

x\rgenti  cyanidum 

Argenti  iodium 

Argenti  nitras 

Argenti  nitras  fusus 

Argenti  oxidum 

Atropina 

Atropinse  sulphas 

Bismuth  subnitras 

Eromum 

Calcii  bromidum 

Calcii  carbonas  prascipitatus    . 

Calcii  chloridum 

Calcii  hypophosphis 

Calcii  phosphas  prsecipitatus  . 

Calx 

Camphora  monobromata  .  .    . 

Chloral 

Cinchonidinse  sulphas  .... 

Cinchonina 

Cinchoninse  sulphas 

Codeina 

Creta  praeparata 

Cupri  acetas 

Cupri  sulphas 

Ferri  chloridum 

Ferri  citras 

Ferri  lactas 

Ferri  sulphas 

Ferri  valerianas • 

Hydrargyri  chloridum  corrosivum: 
Hydrargyri  chloridum  mite  .  . 
Hydrargyri  cyanidum  .... 


WATER. 

ALCOHOL. 

At  15°  C. 

Atl5°C. 

(50°  F.) 

Boiling. 

(50°  F.) 

Boiling. 

Parts. 

Parts. 

Parts. 

Parts. 

30.80 

15 

sp. 

sp. 

500 

15 

3 

I 

25 

3 

15 

5 

20 

_ 

V.   s. 

V.    s. 

V.   s. 

V.    s. 

dec. 

dec. 

0.75 

0.5 

I 

0.5 

100 

3 

4-5 

I 

450 

14 

2.2 

V.    s. 

6 

V.    s. 

0.6 

V.   s. 

0.7 

0.5 

2.5 

0.2 

10.5 

ms. 

0.3 

ms. 

20 

ins. 

0.7 

ms. 

4 

dec. 

dec. 

dec. 

0.5 

V.   s. 

20 

3 

V.   s. 

V.    s. 

V.   s. 

V.   s. 

17 

3 

ms. 

ms. 

ms. 

ms. 

ms. 

ms. 

ms. 

ms. 

ins. 

ms. 

0.8 

0.1 

26 

5 

0.6 

0.5 

25 

5 

V.  sp. 

V.  sp. 

ms. 

ms. 

600 

35 

V.   s. 

V.   s. 

0.4 

V.    s. 

6.5 

V.   s. 

ms. 

ins. 

ms. 

ms. 

33 

dec. 

dec. 

0.7 

V.    s. 

I 

V.   s. 

ins. 

ins. 

ins. 

ins. 

i-S 

V.   s. 

8 

1-5 

6.8 

6 

ins. 

ms. 

ms. 

ms. 

ms. 

ms. 

750 

1300 

ins. 

ms. 

aim.  ins. 

aim.  ins. 

V.    s. 

V.   s. 

V.   s. 

V.    s. 

V.    s. 

V.   s. 

100 

4 

71 

12 

aim.  ins. 

aim.  ins. 

no 

28 

70 

14 

6 

1-5 

80 

17 

V.    s. 

V.   s. 

ms. 

ms. 

ms. 

ins. 

15 

5 

135 

14 

2.6 

0.5 

ins. 

ins. 

V.   s. 

V.   s. 

V.   s. 

V.   s. 

s. 

V.    s. 

ms. 

ins. 

40 

12 

aim.  ins. 

aim.  ins. 

1.8 

0.3 

ins. 

ins. 

ins. 

dec. 

V.    s. 

V.    s. 

16 

2 

2 

1.2 

ms. 

ms. 

ms. 

ms. 

12.8 

3 

IS 

6 

CHEMICALS  SOLVABLE  BY  WATER  AND  ALCOHOL.        127 
Table  of  the  Solubility  of  Chemicals  in  Water  and  Alcohol  (Continued). 


CHEMICALS. 


ALCOHOL. 


At  15°  C. 

(50°  F.) 


One  part  is  soluble  in  : 
Hydrargyri  iodidum  rubrum 
Hydrargyri  iodidum  viride  . 
Hydrargyri  oxidum  flavum  . 
Hydrargyri  oxidum  rubrum. 
Hydrargyrum  ammoniatum  . 
HyoscyaminEe  sulphas  .  .    . 

Iodoform 

lodum ,    .    .    . 

Magnesia 

Magnesii  carbonas 

Magnesii  sulphas 

Magnesii  sulphis 

Mangani  oxidum  nigrum  .  . 

Mangani  sulphas 

Morphina 

Morphinre  acetas 

Morphinae  hydrochloras  .    . 

Morphinre  sulphas 

Phosphorus 

Piperina . 

Plumbi  acetas 

Plumbi  carbonas 

Plumbi  iodidum 

Plumbi  nitras 

Plumbi  oxidum 

Potassa 

Potassii  acetas       

Potassii  bicarbonas  .    ,    .    . 

Potassii  bichromas 

Potassii  bitartras  .    ,    .    .    . 
Potassii  bromidum   .... 

Potassii  carbonas 

Potassii  chloras 

Potassii  citras 

Potassii  cyanidum 

Potassii  ferrocyanidum  .  .    . 
Potassii  hypophosphis  .    .    . 

Potassii  iodidum 

Potassii  nitras 

Potassii  pennanganas  .    .    . 

Potassii  sulphas 

Potassii  tartras 

Quinidinse  sulphas 

Quinina 

Quinines  bisulphas 

Quininte  hydrochloras  .  .    . 

Quinince  sulphas 

Quinine  valerianas  .    .    . 

Saccharum 

Saccharum  lactis 


Parts, 
aim.  ins. 
aim.  ins. 
ins. 
ins. 
ins. 
V.    s. 
ins. 
sp. 
aim.  ins. 
aim.  ins. 
0.8 
20 
ins. 
0.7 
V.  sp. 
12 
24 

24     . 
ins. 
aim.  ins. 
1.8 
ins. 
2000 
2 
ins. 
0.5 
0.4 

ID 
210 

1.6 

I 
16.5 

0.6 

2 

4 

0.6 

0.8 

4 
20 

9 
0.7 

100 

1600 

10 

34 

740 

100 

0.5 

7 


Boiling. 


Parts. 

aim.  ins. 

aim.  ins. 

ins. 

ins. 

ins. 

V.   s. 

ins. 

aim.  ins. 

alrh.  ins. 

0.15 

.'9 

ins. 

0.8 
500 
1-5 
o-S 
.0.75 
ins. 
aim.  ins. 
.0.5 
ins. 
200 
0.8 
ins. 
V.  s. 
V.   s. 
dec. 
1. 5 
15 
I 

0.7 
2 

V.   s. 

I 

2 

0-3 

0.5 

0.4 

3 

4 

o.S 
7 
700 

V.    s. 

I 

30 
40 

0.2 

I 


At  15°  C. 
(50°  F.) 


Boiling. 


Parts. 
130 

ins. 

ins. 

ins. 

ins. 
V.    s. 

80 

II 

ins. 

ins. 

ins. 

ins, 

ins. 

ins. 
100 

68 

63 

702 

V.  sp. 

30 

8 

ins. 

V.  sp. 

aim.  ins. 

ins. 

2 

aim.  ins. 

ins. 
V.  sp. 
200 

ins. 
V.  sp. 
V.  sp. 

sp. 

ins. 

7-3 
18 
aim.  ins. 
dec. 
ins. 
aim.  ins. 
8 
6 
32 
3 
65 
5 
175 
ins. 


Parts. 

15 

ins. 
ins. 
ins. 
ins. 
V.  s. 
15 

ins. 
ins. 
ins. 
ins. 
ins. 
ins. 
36 
14 
31 
144 
V.  sp. 
I 
I 
ins. 
V.  sp. 
aim.  ins. 
ins. 
V.  s. 
V.    s. 
aim.  ins. 
ins. 
V.  sp. 
16 
ins. 
V.  sp. 
V.  sp. 
sp. 
ins. 
3.6 
6 
aim.  ins. 
dec. 
ins. 
aim.  ins. 
V.   s. 

2 
V.    s. 
V.    s. 

3 
I 

28 


128 


DENTAL   MEDICINE. 


Table  of  the  Solubility  of  Chemicals  in  Water  and  Alcohol  (Continued). 


CHEMICALS. 


.    One  part  is  soluble  in  : 

Salicinum 

Soda 

Sodii  acetas 

Sodii  bicarbonas  .... 

Sodii  boras . 

Sodii  carbonas 

Sodii  chloras 

Sodii  chloridum , 

Sodii  hypophosphis  ... 
Sodii  hyposulphis  .... 

Sodii  iodidum 

Sodii  nitras 

Sodii  sulphas, , 

Sodii  sulphis , 

Strychnina , 

Strychninse  sulphas  .'  .    . 

Sulphur  lotum , 

Sulphur  prEEcipitatum  .    .    , 
Sulphur  sublimatum  .  .    .    , 

Thymol , 

Veratrina 

Zinci  acetas 

Zinci  carbonas  prsecipitatus 

Zinci  chloridum 

Zinci  iodidum  ...... 

Zinci  oxidum , 

Zinci  phosphidum 

Zinci  sulphas , 

Zinci  valerianas 


At  15°  C. 
(50°  F.) 


Parts. 
28 

1.7 

3 
12 
16 

1.6 
I.I 
2.8 
I 

1.5 
0.6 

1-3 
2.8 

4 
6700 

10 

ins. 

ins. 

ins. 
1200 
V.  sp. 

.3 

ins. 
V.  s. 
V.   s. 

ins. 

ins. 
0.6 
100 


Boiling. 


Parts. 
0.7 
0.8 

I 

dec. 

0.5 

0.25 

0.5 

2.5 
0.12 

0-5 
0.3 
0.6 
0.4 
0.9 
25000 
2 
ins. 
ins. 
ins. 
900 
V.  sp. 

1-5 

ins. 
V.  s. 
V.    s. 

ins. 

ins. 
0.3 


ALCOHOL. 


At  15°  C. 

(50°  F.) 


Parts. 

30 

V.    s. 

30 

ins. 
ins. 
ins. 
40 
aim.  ins. 
30 
ins. 

1.8 
sp. 
ins. 
sp. 
no 
60 
ins. 
ins. 
ins. 

I 

3 
30 
ins. 
V.  s. 
V.  s. 
ins. 
ins. 
ins. 
40 


Boiling. 


Parts. 

2 
V,    s. 

2 

ins. 
ins. 
ins. 

43 
aim.  ins. 

I 
ins. 

1-4 

40 

ins. 

sp. 

12 
2 

ins. 

ins. 

ins. 
V.  s. 
V.   s. 

.3 

ins. 
V.  s. 
V.   s. 

ins. 

ins. 

ins. 


NATURAL   DISTRIBUTION   OF   REMEDIES. 


129 


Ammonium. 

Barium. 

Calcium. 


NATURAL  DISTRIBUTION  OF  REMEDIES. 

INORGANIC  MATERIA  MEDICA. 

ALKALIES  AND  ALKALINE   EARTHS. 

Cerium.  Potassium. 

Lithium.  Sodium. 

Manganese. 


METALS. 

Aluminum. 

Gold. 

Nickel. 

Antimony. 

Iron. 

Phosphorus. 

Arsenic. 

Lead. 

Silver. 

Bismuth. 

Manganese. 

Zinc. 

Copper. 

Mercury. 

NON-METALS. 

Bromine.     "] 

Charcoal. 

Peroxide  of  Hydrogen, 

Chlorine,      i 

Fluorine.      [Halogens. 

Oxygen. 
Ozone. 

Sulphur. 

Iodine.        J 

ACIDS. 
Orgatiic. 

Acetic. 

Gallic  (pyrogallic). 

Oleic. 

Benzoic. 

Hydrocyanic. 

Salicylic. 

Carbolic. 

Lactic. 

Tannic. 

Citric. 

Meconic. 

Inorganic. 

Tartaric. 

Boric. 

Nitric  (oxalic). 

Phosphoric. 

Chromic. 

Nitrohy  drochloric . 

Sulphuric. 

Hydrochloric. 

Nitrous. 

Sulphurous. 

Hydrobromic. 

CARBON  COMPOUNDS. 

Acetanilid. 

Ethyl  iodide. 

Nitrous  ether. 

Acetic  ether. 

Ethylate  of  sodium. 

Nitrous  oxide. 

Alcohol. 

Ethidene  bichloride. 

Paraldehyde. 

Amyl  Nitrite. 

Fuchsin. 

Petrolatum. 

Antipyrin. 

Hydrocyanic  acid. 

Phenacetin. 

Carbolic  Acid. 

Iodoform. 

Pyrodin. 

Chinolin. 

lodol. 

Resorcin. 

Chloral  hydrate. 

Kairin. 

Salol. 

Chloroform. 

Methylene  bichloride. 

Thallin. 

Croton  Chloral. 

Naphthol,  Naphthalin. 

Trymethylamine, 

Ether. 

Nitroglycerin. 

Ural  (Uralium). 

Ethyl  bromide. 

Urethran. 

130 


DENTAL  MEDICINE. 


ORGANIC    MATERIA    MEDICA. 
Composed  of  the  Vegetable  Kingdom,  which  includes  plants  used  for  medi- 
cinal purposes,  and  the  Animal  Kingdom,  as  follows : 


Cantharides. 

Ichthyol. 

Pancreatin. 

Castor. 

Isinglass. 

Pepsin. 

Cochineal. 

Lanolin. 

Soap. 

Cod  Liver  Oil. 

Lard. 

Spermaceti. 

Albumen  and  Yolk  of  Egg. 

The  Leech. 

Suet. 

Formic  acid. 

Milk. 

Sugar  of  Milk. 

Honey  and  Wax. 

Musk. 

CLASSIFICATION  OF  MEDICINAL  SUBSTANCES 

In  order  to  impress'the  memory  and  facilitate  investigation, 
it  is  necessary  that  medicinal  substances  should  be  classified 
according  to  their  similarity  of  action  on  the  animal  economy, 
as  follows : 


r 


Neurotics,  or  those  which  have  a  special 
action  on  and  modify  the  functions  of  the 
nervous  system.     To  this  group  belong : 


2.  Eccritics,  or  those  which  have  a  special 
action  on  the  secretions.  To  this  group 
belong : 

3.  H^METics,  or  those  which  modify  the  blood. 
To  this  group  belong : 

4.  Topical  Remedies.    To  this  group  belong: 


Hypnotics  and 

Narcotics, 

AnfBsthetics, 

Antispasmodics, 

Tonics, 

Astringents, 

Stimulants, 

Sedatives, 

Spinants. 

Emetics, 

Cathartics,    . 

Diaphoretics, 

Diuretics, 

Blennorrhetics, 

Emmenagogues. 

Haematinics, 

Alteratives, 

Antacids. 

Irritants, 

Demulcents, 

Antiseptics, 

Disinfectants, 

Coloring  Agents. 

Anthelmintics. 


DEFINITIONS   OF   THE   VARIOUS   CLASSES   OF   REMEDIAL 

AGENTS. 

HYPNOTICS    AND    NARCOTICS. 

Hypnotics  and  narcotics  are  medicinal  substances  which 
affect  the  cerebral  and  spinal  functions  by  impairing  or  de- 
stroying nervous  action,  having  first  a  stimulant  effect,  to 
which    their   therapeutic   efficacy   is    in  a  great  degree  due. 


REMEDIAL   AGENTS.  131 

They  allay  cerebral  or  spinal  irritability,  relieve  muscular 
spasm,  and  also  pain,  and  induce  sleep.  When  administered 
to  relieve  pain,  they  are  termed  anodyjies ;  to  induce  sleep, 
they  are  termed  Jiypnotics  or  soporifics. 

Narcotics  fulfill  two  indications,  namely :  Exciting  and  de- 
pressing the  nervous  energy.  For  the  first  it  is  necessary  to 
begin  with  small  doses  and  repeat  them  fi-equently ;  for  the 
second,  a  full  dose  must  be  given  and  not  repeated  for  a  con- 
siderable time.  On  account  of  the  system  becoming  very  soon 
habituated  to  the  action  of  narcotics,  when  it  is  necessary  to 
resort  to  their  use  for  any  length  of  time  the  amount  must  be 
constantly  increased,  in  order  to  maintain  the  same  impression. 
The  difference  between  the  susceptibility  to  their  action  when 
the  body  is  in  a  morbid  or  healthy  condition  should  not  be 
overlooked.  Hypnotics  diminish  the  cerebral  circulation  by 
modifying  vascular  activity. 

Under  narcotics  and  hypnotics  are  classed  such  agents  as 
opium  and  its  different  preparations,  chloral,  lactucarium,  bella- 
donna, stramonium,  hyoscyamus,  tobacco,  lobelia,  conium, 
aconite,  cannabis  indica,  humulus,  camphor,  hydrocyanic  acid, 
aconite,  alcohol,  chloroform,  digitalis,  ether,  paraldehyde, 
potassium  bromide,  sulphonal,  urethran,  zinc  bromide,  etc., 
etc. 

ANESTHETICS. 

Anaesthetics  are  medicinal  agents  which  diminish  sensibility 
and  relieve  pain.  They  are  generally  in  the  form  of  vapors  or 
gases,  applied  by  inhalation,  and  possess  the  power  of  tempo- 
rarily suspending  the  general  sensibility,  being  commonly  em- 
ployed for  the  prevention  of  pain  during  surgical  operations. 
They  are  divided  into  general  and  local  anaesthetics. 

General  anaesthetics  are  agents  capable  of  producing  com- 
plete insensibility  throughout  the  entire  system.  Included  in 
this  class  are  such  agents  as  ether,  chloroform,  nitrous  oxide 
gas,  bromide  of  ethyl,  bichloride  of  methylene,  tetrachloride 
of  carbon,  bichloride  of  ethidene,  bromoform,  iodide  of  ethyl, 
tetrachloride  of  carbon,  trichlorhydrin,  etc.,  etc. 

Local  anaesthetics  are  agents  whose  action  is  limited  to  a 


132  DENTAL   MEDICINE 


certain  part  or  organ,  when  topically  applied,  paralyzing  the 
nerves  of  the  part,  and  temporarily  destroying  the  sensibility. 
Included  in  this  class  are  such  agents  as  absolute  ether,  rhigo- 
lene,  aconite,  pyrethrum,  atropine,  cocaine,  etc.,  etc. 

ANTISPASMODICS. 

Antispasmodics  are  medicinal  agents  which  allay  irregular 
muscular  contraction  or  spasm,  and  compose  the  irregular 
actions  of  the  nervous  system,  without  any  special  or  de-^ided 
effect  on  the  brain.  They  are  employed  in  many  varieties  of 
mental  disturbance,  insanity,  wakefulness,  hypochondriasis, 
convulsions  from  teething,  spasms  from  general  debility,  in 
which  latter  case  an  aromatic  stimulant  of  the  circulation  and 
a  permanent  tonic  prove  beneficial.  In  hysteria,  dependent 
upon  idiopathic  or  primary  nervous  irritation,  the  use  of  anti- 
spasmodics is  indicated.  Included  in  this  class  are  such  agents 
as  asafoetida,  musk,  camphor,  valerian,  galbanum,  ammoniac, 
castor,  compound  spirit  of  ether  (Hoffman's  anodyne),  etc. 

TONICS. 

Tonics  are  medicinal  agents  which  impart  strength  to  the 
system,  producing  a  gradual  and  permanent  increase  of  ner- 
vous vigor,  without  preternatural  excitement.  They  stimulate 
also  in  a  secondary  manner,  by  gradually  increasing  the  force 
of  the  circulation,  and  restoring  the  digestive  and  secretory 
functions  to  a  more  healthy  state,  differing,  however,  from 
stimulants,  in  the  more  permanent  character  of  their  effects. 

Certain  agents  of  this  class,  when  administered  in  large 
doses,  act  as  antiperiodics  in  intermittent  diseases.  Benefit 
also  results  in  the  use  of  tonics  by  alternating  them.  They 
are  divided  into  vegetable  and  mineral  tonics,  the  former  pos- 
sessing a  bitter  extractive  principle,  and  the  latter  uniting 
astringent  with  tonic  properties,  and,  in  the  case  of  prepara- 
tions of  iron,  increasing  the  red  coloring  matter  of  the  blood. 
Such  agents  as  gentian,  quassia,  calumba,  wild  cherry,  serpen- 
taria,  cinchona  and  its  alkaloid  quinine,  salix,  pepsin,  are  ex- 
amples of  vegetable  tonics ;  and  the  preparations  of  iron, 
preparations  of  copper,  preparations  of  zinc,  and  such  agents 


REMEDIAL   AGENTS.  133 

as  subnitrate  of  bismuth,  sulphuric,  nitric,  muriatic  and  oxalic 
acids,  are  examples  of  the  mineral  tonics. 

ASTRINGENTS. 

Astringents  are  medicinal  agents  which  produce  contraction 
of  the  tissues,  having  a  corrugating  power,  either  directly- 
exerted  on  a  part,  or  extended  by  sympathetic  action,  and  thus 
removing  morbid  affections  arising  from  a  state  of  relaxation, 
such  as  inflammation  of  superficial  parts,  hemorrhage  and 
excessive  discharges  from  mucous  membranes.  This  class  of 
remedies  is  important  in  dental  practice,  owing  to  their  great 
efficacy  as  antiphlogistics.  Astringents  are  divided  into  vege- 
table and  mineral,  the  former  owing  their  peculiar  property  of 
astringency  to  the  presence  of  tannic  acid,  while  the  latter 
possess  a  more  decided  astringency,  and  exert  a  sedative  action 
on  the  vascular  system.  In  the  treatment  of  affections  of  the 
mucous  membrane,  such  as  stomatitis,  the  object  is  to  arrest 
•the  inflammatory  action,  which  is  accomplished  by  the  power 
of  the  astringent  remedies  employed  locally  to  increase  the 
tonicity  of  the  tissue,  and  to  diminish  the  calibre  of  the  ves- 
sels supplying  the  part  with  blood,  thus  diminishing  the  quan- 
tity required  for  the  production  of  the  morbid  action.  Besides 
diminishing  the  current  of  the  blood  to  the  inflamed  part, 
astringents  also  exert  an  influence  on  the  pores  or  ducts 
through  which  the  discharge  is  poured  out,  by  diminishing 
their  calibre  also.  Astringents  also  exert  an  influence  on 
morbidly  relaxed  tissues,  when  such  a  condition  results  as  the 
sequelae  of  disease,  especially  in  lymphatic  temperaments, 
where  flabbiness  of  the  soft  tissues  is  characteristic. 

Care,  however,  is  necessary  in  the  use  of  astringents,  for 
when  long  or  immoderately  used  they  may  act  as  direct  irri- 
tants, inducing  inflammation  followed  by  ulceration  and 
sloughing.  They  are  contraindicated  for  the  arrest  of  evacu- 
ations that  are  designated  by  nature  to  relieve  a  plethoric 
state  of  the  system,  unless  such  evacuations  exist  to  an  alarm- 
ing extent.  This  class  of  remedies  can  be  readily  detected  by 
the  taste,  as  they  convey  a  sense  of  roughness  to  the  palate 


134  DENTAL   MEDICINE, 


which  cannot  be  mistaken,  and  which  is  more  marked  in  some 
substances  than  in  others.  Such  agents  as  tannic  acid,  gallic 
acid,  nutgall,  matico,  kino,  catechu,  rhatany,  white  oak  bark, 
creasote,  salicylic  acid,  are  examples  of  the  vegetable  astrin- 
gents; while  the  preparations  of  iron  and  lead,  alum,  sulphuric 
and  nitric  acids  are  examples  of  the  mineral  astringents.  (See 
Styptics}) 

STIMULANTS. 

Stimulants,  also  known  as  excitants  and  hypersthenics,  are 
medicinal  substances  capable  of  exciting  a  temporary  and 
rapid  exaltation  of  the  organic  actions,  the  excitation  thus 
produced  being  extended  or  not  to  the  rest  of  the  system. 
Although  the  stomach  is  the  organ  generally  selected  in  med- 
ical practice  to  be  the  first  impressed  by  stimulants,  on  account 
of  the  extensive  sympathy  which  exists  between  it  and  the 
rest  of  the  system,  in  dental  practice  these  agents  are  topically 
applied  to  the  mucous  membrane  of  the  mouth  as  counter- 
irritants  and  vesicants.  The  influence  of  stimulants  is  most 
apparent  in  conditions  of  morbid  depression,  whereas  in  health 
they  soon  induce  depression.  They  possess  the  power  of 
arousing  the  energies  of  the  nervous  system,  and  hence  are 
beneficial  in  many  nervous  disorders,  especially  those  of  a 
spasmodic  nature.  When  applied  to  the  gastro-intestinal  canal 
they  promote  digestion  as  stomachics,  and  when  administered 
to  dispel  flatulence  they  are  known  as  carminatives.  When 
internally  administered,  it  is  for  the  most  part  advisable  to  be- 
gin with  small  doses,  and  increase  them  as  circumstances  may 
require.  In  some  cases,  however,  it  is  necessary  to  give  them 
freely  from  the  first.  It  is  often  requisite  to  change  the  stimu- 
lating substance  and  also  the  part  of  the  body  to  which  it  is 
applied ;  when  the  stomach  fails,  the  rectum  and  skin  may  be 
acted  upon  beneficially.  Topically  applied,  stimulants  irritate 
and  inflame  the  parts  with  which  they  come  in  contact,  and 
are  then  known  as  irritants. 

The  most  powerful  and  rapid  stimulants  are  known  as 
diffusible,  while  others  of  a  vegetable  nature,  containing  a  vol- 
atile oil,  are  termed  aromatic.    Among  the  class  of  diffusible 


REMEDIAL  AGENTS.  135 

stimulants  are  such  agents  as  alcohol,  preparations  of  am- 
monia, arnica,  phosphorus,  etc.,  etc.  Among  the  class  of 
aromatic  stimulants  are  capsicum,  cinnamon,  black  pepper, 
mace,  cloves,  pimento,  oil  of  turpentine,  ginger,  cardamon, 
calamus,  gaultheria,  peppermint,  origanum,  etc.,  etc. 

SEDATIVES. 

Sedatives  are  medicinal  substances  employed  to  diminish  the 
frequency  of  the  action  of  the  circulation,  their  therapeutic 
influence  being  due,  it  is  thought,  to  a  stimulant  character. 
They  reduce  vascular  excitement,  and  while  relieving  irrita- 
bility and  irregularity  of  the  heart's  action,  their  first  effect  is 
to  restore  its  tone  and  force  when  it  is  in  a  morbidly  depressed 
condition.  Substances  known  as  refrigerants,  which  possess 
the  power  of  diminishing  febrile  heat,  allaying  thirst,  restoring 
the  secretions,  and  which  comprise  almost  all  of  the  neutral 
alkaline  salts,  are  also  included  with  sedatives.  Among  the 
'class  known  as  sedatives  are  digitalis,  American  hellebore 
(veratrum  viride),  white  hellebore  (veratrum  album),  yellow 
jasmine  (gelsemium),  tartar  emetic,  nitrate  of  potassium,  etc., 
etc.  Among  the  class  known  as  refrigerants  are  borate  of 
soda,  citrate  of  potassium,  acetate  of  ammonia,  spirit  nitrous 
ether,  and  vegetable  acids. 

SPINANTS. 

Spinants  or  spastics  are  medicinal  substances  employed  to 
excite  muscular  contraction.  Vegetable  spinants  containing 
the  alkaloids  strychnia  and  brucia,  and  employed  therapeuti- 
cally in  cases  of  torpid  and  paralytic  conditions  of  the  mus- 
cular system,  are  the  most  important  of  this  class  ;  also  ergot, 
which  is  employed  to  excite  muscular  contraction  of  the 
uterus.  Among  the  class  of  spinants  are  such  agents  as  nux 
vomica,  and  its  alkaloid  strychnine,  ignatia,  cotton-root  bark, 
ergot. 

EMETICS. 

Emetics  are  medicinal  substances  which  excite  vomiting, 
their  action  being  independent  of  any  effect  arising  from  the 
quantity  of  the  agent  introduced  into  the  stomach. 


136  DENTAL  MEDICINE. 


While  the  action  of  an  emetic  is  local  as  regards  the  stomach, 
it  extends  to  almost  every  organ  of  the  body,  and  in  order 
that  a  substance  of  this  kind  shall  produce  its  effect  upon  the 
stomach,  it  must  first  make  an  impression  upon  the  cerebro- 
spinal axis.  Within  fifteen  or  twenty  minutes  after  an  emetic 
is  administered  there  is  experienced  a  feeling  of  distress,  re- 
laxation and  faintness,  with  a  cool,  moist  skin  and  small, 
feeble  and  irregular  pulse,  such  symptoms  increasing  until 
emesis  occurs ;  during  which  the  face  becomes  flushed,  the 
pulse  full  and  frequent,  with  an  increase  in  the  temperature  of 
the  body.  When  the  action  of  vomiting  is  over,  the  skin 
again  becomes  moist,  the  pulse  soft  and  feeble,  and  a  languid 
and  drowsy  feeling  is  experienced.  Whatever  may  be  the 
apparent  necessity  for  evacuating  the  stomach,  all  the  circum- 
stances of  the  case  must  be  considered,  and,  especially  if  there 
be  much  arterial  excitement,  with  determination  to  the  head, 
blood-letting  should  sometimes  be  premised. 

When  the  full  dose  of  an  emetic  is  requisite,  as  in  cases  of 
poisoning,  the  object  is  to  evacuate  the  contents  of  the  stomach 
as  speedily  as  possible;  but  in  other  cases  it  is  better  to  ad- 
minister the  emetic  substance  in  divided  doses,  frequently 
repeated,  until  the  desired  effect  is  produced. 

In  cases  of  torpor  or  congestion,  it  is  sometimes  necessary 
to  arouse  the  system  by  retching  or  vomiting,  which  may  be 
done  by  administering  the  emetic  with  only  a  small  quantity 
of  fluid ;  but  when  the  object  is  to  empty  the  stomach  and 
duodenum  merely,  free  draughts  of  tepid  water  or  weak  cham- 
omile tea  may  be  given  as  soon  as  nausea  occurs.  When  the 
excitability  of  the  stomach  is  greatly  diminished  by  a  narcotic, 
as  in  cases  of  poisoning,  it  is  necessary  to  assist  the  emetic  by 
the  addition  of  some  excitant.  Vinegar,  mustard  or  ammonia 
answer  as  excitants,  when  such  an  effect  is  caused  by  opium  ; 
but  the  stomach-tube  is  the  best  resource. 

There  are  some  few  cases  where  emetics  cannot  be  em- 
ployed with  safety,  as  in  congestion  of  the  brain,  a  great  deter- 
mination of  blood  to  the  head  dependent  upon  constitutional 
causes,  pregnancy,  hernia,  active  hemorrhage  from  the  lungs 


REMEDIAL   AGENTS.  137 


and  uterus,  acute  gastritis,  etc.,  etc. ;  and  if  emetics  are  allow- 
able in  such  diseases  or  conditions,  it  is  in  nauseating  doses 
only.  When  they  are  used  merely  to  excite  nausea,  they  are 
termed  nmiseants. 

Emetics,  by  frequent  use,  are  prone  to  cause  an  increased 
susceptibility  of  the  stomach  to  their  action ;  hence,  persons 
of  delicate  habits  should  use  them  cautiously. 

Therapeutically,  emetics  are  employed  to  evacuate  the 
stomach  in  cases  of  poisoning,  undigested  food,  etc.,  to  expel 
foreign  substances  from  the  throat  or  oesophagus;  to  excite 
nausea,  in  order  to  depress  the  vascular  and  muscular  systems  ; 
to  relieve  spasm;  to  promote  secretion  and  excretion,  and 
to  make  decided  impressions  in  the  forming  stages  of  certain 
fevers  and  delirium  tremens. 

To  relieve  excessive  vomiting,  resulting  from  the  use  of 
emetics,  ice  broken  in  small  pieces  and  swallowed  ;  lime  water 
and  milk  (a  teaspoonful  of  each,  mixed  cold  and  given  at  inter- 
vals of  15  or  20  minutes);  a  drop  of  creasote  in  a  wineglass 
of  water  (a  tablespoonful  given  every  1 5  or  20  minutes);  J^ 
drop  of  diluted  hydrocyanic  acid  in  syrup  and  water,  or  in 
syrup  of  wild  cherry  bark  (given  every  15  minutes);  or  in- 
fusion of  camphor  (made  with  boiling  water  and  given  cold, 
a  teaspoonful  frequently  repeated) ;  brandy  and  water ;  clove 
or  green  tea;  an  anodyne  injection;  counter-irritant  to  the 
stomach  (as  a  mustard  plaster,  or  hot  fomentation  of  brandy 
and  clove  or  spice  plaster). 

Among  the  class  of  vegetable  emetics  are  ipecacuanha,  san- 
guinaria,  mustard,  lobelia,  tobacco,  squill;  and  mineral  emetics, 
such  as  sulphate  of  zinc,  sulphate  of  copper,  tartar  emetic, 
alum,  common  salt,  turpeth  mineral. 

CATHARTICS. 

Cathartics  or  purgatives  are  medicinal  agents  which  evacu- 
ate the  bowels,  and  are  capable  of  fulfilling  three  different  in- 
dications:  I.  Simply  to  evacuate  the  bowels.  2.  To  excite  an 
increased  discharge  from  the  mucous  coat  of  the  intestines, 
and  3.  To  stimulate  the  neighboring  viscera  and  cause  them 


138  DENTAL  MEDICINE. 


to  secrete  a  greater  quantity  of  their  peculiar  fluids.  When 
they  produce  watery  discharges  by  stimulating  the  mucous 
follicles  and  exhalants,  they  are  termed  hydragogues.  When 
given  in  overdoses  they  are  so  powerful  as  to  produce  violent 
vomiting  and  purging,  pain  in  the  abdomen,  cold  extremities 
and  a  sinking  pulse.  Several  different  cathartics  are  usually 
combined  in  one  formula,  when  it  is  desired  to  produce  all  of 
the  indications  above  referred  to.  Some  agents  of  this  class 
produce  their  effect  by  absorbing  the  acid  generated  in  the 
alimentary  canal,  thus  becoming  converted  into  a  purgative 
salt,  as  magnesia,  for  example.  Others  expend  their  principal 
force  upon  the  rectum  and  large  intestines,  and  for  this  reason 
are  advantageously  employed  in  affections  of  the  lower  bowels, 
and  the  uterus  and  its  appendages,  such  as  aloes,  for  example. 
Cathartics  should  always  be  given  on  an  empty  stomach.  If 
administered  immediately  after  a  full  meal,  they  arrest  the 
digestive  process,  are  liable  to  cause  nausea,  if  not  vomiting, 
and  do  not  evacuate  the  bowels  with  the  same  certainty  or 
effect. 

When  simple  costiveness  is  to  be  removed,  the  cathartic 
may  be  administered  in  the  evening,  and,  if  not  sufficient,  the 
dose  can  be  repeated  in  the  morning  and  at  regular  intervals 
through  the  day,  until  the  effect  is  produced. 

In  administering  cathartics,  the  excitement  is  to  be  con- 
tinued till  the  requisite  action  is  induced,  yet  not  sufficient  to 
prove  an  irritant.  But  in  the  treatment  of  many  diseases,  it 
is  preferable  to  purge  through  the  day,  in  order  that  the  sleep 
may  not  be  disturbed  at  night.  The  operation  of  cathartics 
may  be  very  much  accelerated  by  the  free  use  of  diluent 
drinks,  such  as  gruel,  barley  water,  etc.,  etc.  By  combining 
these  remedies,  the  action  of  many  of  them  is  modified  and 
controlled  ;  and  some  of  the  more  powerful  may  be  made  to 
operate  mildly  and  certainly  by  uniting  small  quantities  of 
several  of  them  in  the  same  dose. 

The  addition  of  an  emetic  substance,  such  as  ipecacuanha, 
or  tartar  emetic,  gives  activity  to  the  combination,  while  it 
modifies  the  harshness  of  the  powerful  cathartics. 


REMEDIAL   AGENTS.  139 


The  operation  of  a  cathartic  may  often  be  promoted  by- 
judicious  venesection,  and  if  there  is  spasm  of  the  intestines, 
opium  may  be  advantageously  added  to  the  cathartic. 

Cathartics  act  not  only  upon  the  bowels,  but  upon  distant 
parts,  as  every  portion  of  the  organism  is  capable  of  being 
impressed  by  them.  Cathartics  are  divided,  according  to  the 
intensity  of  th^ir  operation,  into  laxatives,  purgatives  and 
drastics,  to  which  may  also  be  added  eneniata.  Laxatives 
gently  stimulate  the  mucous  coat  of  the  intestines,  and  hence 
they  are  well  adapted  for  cases  in  which  the  sole  indication  is 
to  unload  the  bowels  of  their  contents.  Purgatives  are  more 
powerful  in  their  operation ;  they  excite  a  copious  exhalation 
from  the  mucous  lining  of  the  intestines,  and  augment  the 
peristaltic  action  to  a  great  degree.  Drastics  are  the  more 
powerful  and  violent  cathartics,  and  produce  a  greater  degree 
of  irritation"  in  the  lining  membrane  of  the  intestines,  and 
occasionally  act  upon  the  nerves  of  the  stomach,  so  as  to  cause 
nausea  and  sometimes  vomiting.  Drastics  generally  belong  to 
the  resino-extractive  substances,  and  act  violently,  on  account 
of  being  sparingly  soluble  and  adhering  to  the  mucous  coat 
of  the  intestines. 

Enemata  are  agents  of  this  class  which  act  on  the  lower 
part  of  the  intestinal  tube  by  direct  application  ;  they  irritate 
the  lining  membrane  of  the  rectum,  and  by  sympathy  of  con- 
tinuity, their  influence  is  extended  to  the  intestinal  canal. 
Hence  enemata  may  be  employed  with  advantage  when  cathar- 
tics cannot  be  given  by  the  mouth,  as  when  deglutition  is 
impracticable.  What  are  known  as  saline  cathartics  are  em- 
ployed in  the  treatment  of  febrile  and  inflammatory  affections, 
as  they  do  not  produce  any  excitant  action  on  the  general 
system.  There  are  also  acrid  cathartics,  which  are  not  violent 
enough  to  cause  inflammation.  Others  are  known  as  mercurial 
cathartics.  The  class  known  as  laxatives  comprise  such  sub- 
stances as  certain  articles  of  diet,  as  ripe  and  dried  fruits,  such 
as  tamarinds,  peaches,  raisins,  figs,  prunes,  also  molasses, 
honey,  cracked  wheat,  Indian  meal  and  oatmeal,  etc.,  etc. 
Other  laxatives  are  castor  oil,  manna,  sulphur,  purging  cassia. 


140  DENTAL  MEDICINE. 


etc.,  etc.  Saline  cathartics  comprise  such  substances  as  mag- 
nesia, carbonate  and  sulphate  of  magnesia  (Epsom  salts), 
solution  of  citrate  of  magnesia,  sulphate  of  sodium  (Glauber's 
salt),  sulphate  of  manganese,  phosphate  of  sodium,  sulphate 
of  potassium,  cream  of  tartar,  soluble  tartar,  Rochelle  salts. 
Mild,  acrid  cathartics  comprise  such  substances  as  rhubarb, 
aloes,  senna,  leptandra,  elder.  Drastic  cathartics  comprise  such 
substances  as  jalap,  may  apple,  scammony,  colocynth,  gam- 
boge, elaterium,  croton  oil.  Mercurial  cathartics  consist  of 
calomel,  blue  mass,  mercury  with  chalk.  Eneniata  consist  of 
tepid  water,  flaxseed  tea  or  other  demulcent  infusion;  a  com- 
bination of  a  tablespoonful  each  of  common  salt,  molasses 
and  lard  or  olive  oil,  in  two-thirds  of  a  pint  of  warm  water,  to 
which  castor  oil  or  Epsom  salt  may  be  added  to  augment  the 
cathartic  effect,  is  a  formula  for  the  common  laxative  enema. 
(See  Purgatives}^ 

DIAPHORETICS. 

Diaphoretics,  known  also  as  sudorijics,  are  medicinal  sub- 
stances capable  of  producing  perspiration,  or  an  increase  of 
the  cutaneous  discharge,  which  may  be  occasioned  by  the 
mere  drinking  of  a  large  quantity  of  fluid,  provided  the  tem- 
perature of  the  system  be  kept  up.  The  determination  of 
blood  to  the  cutaneous  vessels  by  a  warm  temperature  or 
exercise  will  produce  diaphoresis,  and  the  action  of  nauseat- 
ing agents,  by  relaxing  the  orifices  of  the  cutaneous  vessels, 
and  also  stimulants,  by  exciting  such  vessels  to  increased 
secretion,  will  have  the  same  effect. 

The  external  application  of  heat,  friction,  etc.,  stimulates 
the  cutaneous  capillaries  and  causes  an  increased  secretion. 

Diaphoresis  may  also  be  excited  by  medicines  which  enter 
the  circulation  and  stimulate  the  cutaneous  vessels  by  contact, 
such  as  the  mercurials  and  sulphur  ;  also  by  medicines  which 
act  on  the  surface  sympathetically,  through  the  medium  of 
the  stomach,  as  cold  drinks,  etc. 

Diaphoresis  may  also  be  produced  by  increasing  the  gen- 
eral action  of  the  vascular  system,  by  such  means  as  violent 
exercise,  the  warm  bath,  and  by  the  use  of  alcohol,  ammonia, 


REMEDIAL  AGENTS.  141 


guaiacum,  etc. ;  it  may  also  be  produced  by  the  use  of  agents, 
capable  of  relaxing  the  morbidly  constricted  mouths  of  the 
perspiratory  vessels,  such  as  the  antimonials,  saline  diaphor- 
etics, and  by  the  operation  of  venesection. 

Nauseating  diaphoretics  are  employed  to  produce  a  power- 
ful relaxing  action  in  inflammatory  cases  not  complicated  with 
gastric  irritability,  and  for  such  effects  the  emetics  ipecacu- 
anha and  the  preparations  of  antimony  are  administered. 

Refrigerant  diaphoretics  are  employed  to  produce  a  gentle 
relaxing  effect  in  allaying  febrile  excitement  and  reducing  the 
temperature  of  the  body. 

Sthmdating  diaphoretics  are  employed  in  rheumatic  and 
pulmonary  affections,  after  vascular  excitement  has  been 
reduced,  and  where  the  surface  is  cool,  being  contraindicated 
in  a  high  degree  of  inflammation.  For  such  effects,  the  dif- 
fusible stimulants,  aromatic  substances,  and  such  narcotics  as 
opium  and  camphor  are  administered.  During  the  adminis- 
tration of  diaphoretics,  the  patient  should  be  confined  to  bed, 
and  when  diaphoresis  is  excited,  it  should  not  be  suddenly 
checked.  Venesection  is  generally  resorted  to  when  there  is 
great  arterial  excitement  with  undue  heat  of  skin,  before  the 
attempt  is  made  to  administer  diaphoretics. 

Belonging  to  the  class  of  diaphoretics  are  such  agents  as 
Dover's  powder,  guaiac,  spirits  of  mindererus,  nitrate  of 
potassa,  sweet  spirit  of  nitre,  etc.,  etc. 

DIURETICS. 

Diuretics  are  medicinal  substances  which  act  upon  the 
kidneys,  and  produce  an  increased  flow  of  urine. 

Remedies  of  this  class  act  immediately  and  specially  upon 
the  kidneys,  some  reaching  these  organs  by  first  passing 
through  the  blood,  without  being  decomposed,  while  others, 
on  the  contrary,  undergo  changes  in  the  first  passages,  the 
result  of  such  changes  exciting  diuresis.  The  principal  use 
of  diuretics  is  to  promote  the  absorption  of  dropsical  effusions. 
They  are  also  employed  to  correct  nephritic  disorders,  accom- 
panied with   obstructed   secretion  in   calculi    of  the  kidneys, 


142  DENTAL  MEDICINE. 


ureters  and  bladder,  and,  as  evacuants,  to  reduce  inflamma- 
tion. 

Where  there  is 'great  arterial  excitement,  a  judicious  use  of 
a  lancet  is  recommended,  prior  to  the  administration  of  diu- 
retics, the  patient  being  kept  cool,  to  avoid  perspiration. 

To  insure  the  full  effect  of  diuretics,  diluent  drinks  should 
be  freely  given,  and  especially  such  as  contain  some  diuretic 
substance.  Included  in  the  class  of  diuretics  are  such  agents 
as  squill,  nitre,  cubebs,  juniper,  colchicum,  erigeron,  cream  of 
tartar,  copaiba,  podophyllum,  etc.,  etc. 

BLENNORRHETICS. 

Blennorrhetics  are  medical  substances  which  increase  the 
secretion  of  the  mucous  membranes,  and  are  employed  in 
morbid  conditions  of  such  membranes,  in  order  to  restore 
them  to  healthy  action,  in  cases  where  their  secretion  is  defi- 
cient, excessive  or  abnormal  in  quality.  They  are  termed 
expectorants  when  used  to  stimulate  the  secretion  of  mucus 
from  the  bronchial  or  laryngeal  membranes,  as  in  bronchitis 
and  laryngitis,  and  during  convalescence,  in  pneumonia.  The 
oleo-resinous  agents  of  this  class  are  employed  in  chronic 
diarrhoea,  and  the  diarrhoea  of  typhoid  fever,  such  as  oil  of 
turpentine,  for  example ;  also  in  diseases  of  the  urino-genital 
mucous  membranes,  such  as  gonorrhoea,  gleet,  leucorrhoea, 
incontinence  of  urine,  cystitis,  etc.,  etc.  Included  in  the  class 
of  blennorrhetics  are  such  agents  as  senna,  cimicifuga,  garlic, 
turpentine,  squill,  copaiba,  cubebs,  matico,  buchu,  myrrh,  ben- 
zoin, storax,  balsam  of  peru,  balsam  of  tolu,  etc.,  etc. 

EMMENAGOGUES, 

Emmenagogues  are  medicinal  substances  which  promote 
the  menstrual  discharge,  or  restore  it  when  entirely  sup- 
pressed. The  particular  emmenagogue  required  depends 
upon  the  cause  of  the  amenorrhoea;  for  example,  when  anae- 
mia is  the  cause,  the  preparations  of  iron  prove  most  effectual ; 
when  from  plethora,  blood  letting  and  cathartics  or  evacuants 
are  resorted  to.  Certain  medicinal  substances  excite  the  pelvic 
circulation,  and  stimulate  the  parts  in   direct  connection  with 


REMEDIAL   AGENTS.  143 

the  uterus,  and  thereby  increase  or  promote  the  menstrual 
discharge. 

General  debility  being  the  cause  of  the  local  affection,  an 
active  administration  of  tonics,  in  connection  with  the  emmen- 
agogue  required,  is  advisable. 

The  most  prominent  of  this  class  of  emmenagogues  are 
savine,  cantharides,  ergot,  cotton  root,  Seneca,  snake  root, 
guaiacum,  etc.,  etc. 

H^MATINICS. 

Haematinics  are  medicinal  substances  which  increase  the 
number  of  blood  corpuscles,  or  the  amount  of  haematin  in  the 
blood,  and  hence  are  administered  in  such  diseases  as  are 
dependent  on  a  deficiency  of  these  elements. 

This  class  of  remedies  includes  the  preparations  of  iron  or 
chalybeates,  which  are  capable  of  causing  changes  in  the  con- 
dition of  the  blood,  and  also  general  and  local  tonic  effects. 

ALTERATIVES. 

Alteratives  are  medicinal  substances  which  are  capable, 
when  administered  in  small  doses,  of  removing  morbid  struc- 
tures and  conditions,  without  any  sensible  evacuation;  in  other 
words,  changing,  in  some  inexplicable  and  insensible  manner, 
certain  morbid  actions  of  the  system. 

Alterative  remedies  re-establish  the  healthy  functions  of  the 
animal  economy  in  a  slow  but  decided  manner,  acting  on  the 
various  secreting  organs,  sometimes  without  any  sensible 
increase  of  the  secretions  themselves.  The  effect  of  minute 
doses  of  mercury,  iodine  and  other  substances,  upon  the 
glandular  apparatus,  afford  examples.  Medicinal  remedies  of 
almost  every  class  become  alteratives  by  being  administered 
in  very  small  doses,  at  intervals  of  a  few  hours ;  and  they  are 
generally  classed  with  stimulants  and  tonics,  and  some  of 
them  with  narcotics.  By  their  action  the  secretions  and 
exhalations  are  increased ;  the  exudation  of  plastic  or 
coagulable  lymph  is  diminished ;  the  formation  of  false  mem- 
branes checked;  the  textures  softened;  inflammatory  action 
arrested  ;  and  morbid  growths  and  deposits  absorbed.     Phleg- 


144  DENTAL  MEDICINE. 


monous  inflammation  is  arrested,  and  visceral  and  glandular 
enlargements  are  dispelled.  But  if  administered  too  freely, 
the  blood  may  become  so  impoverished  as  to  interfere  with 
the  functions  of  nutrition,  and  a  marasmatic  or  cachectic  con- 
dition be  produced,  the  textures  being  softened,  or  even 
destroyed.  Hence  this  class  of  remedies  should  be  carefully 
administered,  and  their  effects  be  closely  observed.  The  chief 
use  of  alteratives  is  antiphlogistic  or  resolvent;  for  example, 
the  mercurials  are  generally  employed  in  acute  inflammation, 
and  the  preparations  of  iodine  and  bVomine  in  chronic  inflam- 
mations. 

Included  in  this  class  are  the  preparations  of  mercury, 
iodine,  iodide  of  potassium,  iodoform,  bromine  preparations 
of  arsenic,  phosphate  and  hypophosphite  of  lime,  chlorate  of 
potassium,  permanganate  of  potassium,  chlorine  water,  chlor- 
inated lime,  etc.,  etc. 

ANTACIDS. 

Antacids  are  medicinial  substances,  capable  of  neutralizing 
acidity  of  the  blood,  the  secretions,  etc.,  by  combining  with 
the  acid  and  counteracting  it. 

The  alkalies,  alkaline  earths,  and  their  carbonates  are  the 
substances  included  in  this  class,  and  the  former  are  more 
energetic  in  their  action  than  the  alkaline  earths,  such  as 
magnesia.  The  carbonates  of  these  earths  have  little  or  no 
chemical  influence  upon  the  tissues. 

This  class  of  remedies,  in  the  form  of  alkaline  preparations, 
are  administered  internally  as  antacids  in  cases  where  an  un- 
usual quantity  of  acid  is  generated  in  the  stomach — a  com- 
mon symptom  of  dyspepsia,  which  is  indicated  by  acid  eruc- 
tations, violent  heartburn  and  marked  effervescence  when  a 
carbonated  alkali  is  taken ;  the  acid  in  the  stomach  laying 
hold  of  the  alkaline  base,  and  resulting  in  a  large  quantity  of 
carbonic  acid  being  driven  off. 

Alkalies  are  also  employed  to  relieve  irritability  of  the 
stomach  and  check  vomiting ;  also  as  antidotes  in  cases  of 
poisoning  from  acids ;  also  as  antilithics,  to  neutralize  lithic 
acid  when  it  is  separated  in  unusual  quantity  by  the   urinary 


REMEDIAL  AGENTS.  145 

secretion;  also  as  litJiontriptics,  or  solvents  of  calculi,  more 
particularly  lithates  ;  also  employed  in  cases  of  acute  rheuma- 
tism and  gout,  to  neutralize  the  excess  of  acid  in  the  blood ; 
also  in  diabetes  mellitus,  and  to  relieve  irritability  of  the  urin- 
ary organs,  cutaneous  irritation,  itching  of  the  anus,  especially 
when  such  conditions  are  dependent  on  an  excess  of  acid  in 
the  system ;  and  also  as  antiplastics  and  resolvents  in  inflam- 
mation, and  as  diuretics.  As  a  general  rule,  the  administra- 
tion of  antacids  should  be  preceded  by  an  emetic  or  cathartic, 
and  in  some  cases  both. 

When  a  permanent  effect  is  desired,  antacids  are  usually 
combined  with  tonics  and  aromatics,  and  occasionally  with 
narcotics;  for  when  given  alone  the  relief  afforded  is  but 
transient.  To  prevent  an  irritant  and  purgative  action  on  the 
bowels,  and  also  to  facilitate  their  absorption,  antacid  prepara- 
tions are  administered  in  a  state  of  large  dilution. 

In  dental  practice  antacids  are  also  employed  for  correcting 
acidity  of  the  fluids  of  the  mouth,  often  a  result  of  acid  eructa- 
tions from  the  stomach.  The  class  of  antacids  comprise  the 
preparations  of  potassium,  sodium,  lithium,  ammonium,  mag- 
nesium and  calcium.  The  antacids  employed  in  dental  prac- 
tice are  principally  precipitated  chalk,  lime  water,  carbonate 
of  soda,  etc. 

IRRITANTS. 

The  medicinal  substances  recognized  as  irritants  are  sub- 
divided into  rubefacients,  epispastics,  sup  pur  ants  and  escharotics . 

Rubefacients  are  agents  employed  to  redden  the  surface 
by  exciting  the  action  of  the  capillaries,  and  occasioning  an 
afflux  of  vascular  and  nervous  power  to  the  part  with  which 
they  come  in  contact ;  hence  pain  is  a  usual  consequence  of 
their  employment. 

They  are  used  for  the  same  purposes  as  blisters,  and  are 
often  a  good  substitute  for  them;  for  example,  in  low  degrees 
of  inflammation,  as  local  anodynes,  as  general  stimulants  ; 
their  efificacy  as  such  depending  upon  their  action  on  the 
capillary  circulation,  and  also  on  the  pain  they  occasion.  They 
are  especially  serviceable  in  the  coma  and  asphyxia  resulting 
10 


146     '  DENTAL   MEDICINE. 


from  poisons  and  drowning,  but  in  cases  of  cerebral  oppres- 
sion are  inferior  to  blisters.  Rubefacients  are  used  until  red- 
ness and  pain  occur,  and  their  persistent  application  will  cause 
vesication,  and  even  gangrene. 

In  the  class  of  rubefacients  are  included  mustard,  capsicum, 
oil  of  turpentine,  ammonia,  liniment.  Burgundy  pitch,  Canada 
pitch,  ginger,  black  pepper,  garlic  and  spice  plaster. 

Epispastics,  also  called  vesicants  and  blisters,  are  medicinal 
agents,  capable  of  producing,  when  applied  to  the  skin,  inflam- 
mation followed  by  an  effusion  of  serum  beneath  the  cuticle. 
As  a  general  rule,  blisters  should  remain  on  the  surface  of 
the  skin  six  or  eight  hours,  in  order  to  insure  their  full  effect. 
When  the  skin  is  very  delicate  a  shorter  application  will 
answer  every  purpose  •  and  in  the  case  of  children  it  is  seldom 
necessary  for  them  to  remain  longer  than  three  or  four  hours. 
When  applied  to  the  scalp,  twelve  hours  are  generally  re- 
quired. After  removing  a  blister,  the  usual  dressing  is  some 
non-irritating  ointment,  such  as  simple  cerate.  In  acute  dis- 
eases, blistering  ought  never  to  precede  such  means  as  have  a 
tendency  to  reduce  inflammatory  action,  and  the  application 
should  be  as  near  the  affected  part  as  possible. 

Covering  blisters  with  fine  gauze  renders  them  much  less 
irritating,  and  does  not  retard  their  operation. 

If  a  blister  is  applied  long  enough  to  redden  the  skin,  a 
simple  poultice  will  complete  the  vesication  ;  and  in  the  case 
of  children  this  method  should  always  be  pursued.  When  it 
is  necessary  to  keep  the  blister  open,  weak  epispastic  or  savin 
ointment  will  prove  sufficient.  When  the  circulation  is  lan- 
guid in  the  extremities,  they  seldom  act  efficiently,  and  may 
cause  gangrene  by  exhausting  what  vitality  remains.  When 
strangury  is  produced,  the  blister  must  be  removed  after  three 
or  four  hours,  and  the  part  bathed  with  olive  oil,  or  a  poultice 
applied,  and  diluent  drinks  used ;  an  opium  suppository  or 
injection  will  prove  serviceable.  Epispastics  are  employed  as 
local  stimulants  in  the  treatment  of  inflammation ;  to  create  a 
healthy  inflammatory  action,  as  in  various  cutaneous  eruptions  ; 
to  relieve  pain ;  to  destroy  morbid  associations  by  causing  a 


REMEDIAL   AGENTS.  147 

powerful  impression ;  to  stimulate  the  absorbing  or  secreting 
vessels  of  parts  in  the  neighborhood  of  the  affected  part ;  to 
stimulate  generally ;  to  relieve  threatened  gangrene  and  pa- 
ralysis ;  to  produce  local  depletion  as  evacuants,  and  to  pre- 
pare a  surface  for  the  endermic  application  of  medicines. 

The  class  of  epispastics  include  such  agents  as  cantharides, 
cantharidal  collodion,  water  of  ammonia,  etc. 

SuppuRANTS  are  medicinal  agents,  which,  when  rubbed  on 
the  skin,  cause  rubefaction,  accompanied  by  a  pustular  erup- 
tion ;  their  beneficial  effects  being  due  to  the  counter-irritation 
set  up.  The  agents  of  this  class  are  generally  employed  in 
subacute,  chronic  laryngeal  and  bronchial  affections,  diseases 
of  the  joints,  etc.,  etc. 

Included  as  suppurants  are  croton  oil,  antimonial  oint- 
ments, etc.,  etc. 

EscHAROTics,  called  also  Cauterants  or  Caustics,  are  medi- 
cinal agents  capable  of  destroying  the  structure  and  vitality  of 
the  parts  with  which  they  come  in  contact,  producing  an 
eschar  or  slough,  which  is  followed  by  inflammation  and  sup- 
puration of  the  neighboring  tissues  to  such  a  degree  that  the 
slough  separates  from  the  living  parts.  The  mode  of  action  of 
an  escharotic  is  as  follows :  After  being  applied  to  the  skin, 
so  as  to  chemically  disorganize  it,  or  destroy  its  vitality,  a 
new  action  is  set  up  in  the  vessels  beneath  the  slough,  so  as  to 
cause  it  to  be  thrown  off.  The  excavation  resulting  is  then 
kept  open  by  inserting  some  irritant,  which  maintains  a  copious 
secretion  of  pus  from  the  ulcerated  surface.  Escharotics  are 
divided  into  Actual  and  Potential ;  the  actual  being  fire  itself, 
while  the  potential  are  substances  which  destroy  the  living 
solids  either  by  excessive  stimulation,  or  by  producing  a 
chemical  decomposition. 

Iron  heated  to  a  white  heat  and  the  moxa  (cones  or  cylin- 
ders of  inflammable  substance)  represent  the  actual  cautery ; 
and  caustic  potash,  nitrate  of  silver,  burnt  alum,  chloride  of 
zinc,  chromic,  sulphuric  and  nitric  acids,  and  the  nerve  or 
arsenical  paste  employed  in  dental  practice,  represent  the 
potential  cautery.    A  sub-class  is  composed  of  what  are  known 


148  DENTAL   MEDICINE. 


as  •  Issues  and  Setons  ;  the  blister  issue,  where  the  skin  is  re- 
moved by  a  blister,  and  the  discharge  promoted  by  means  of 
stimulating  applications,  as  the  cantharidal  ointment,  for  ex- 
ample ;  also,  the  pea-issue,  where  an  incision  made  by  the  lancet 
is  kept  open  by  means  of  a  pea,  beet,  or  piece  of  orris  root. 
The  Seton  is  prepared  as  follows  :  A  seton  needle,  to  which  is 
attached  a  skein  of  silk,  is  passed  completely  through  the  part 
chosen  for  the  operation,  after  which  it  is  removed,  and  the 
ends  of  the  silk  left  hanging  from  the  wound.  It  is  dressed 
once,  or  several  times  a  day,  with  some  mild  ointment ;  or,  if 
this  is  not  sufficient  to  keep  up  the  discharge,  a  more  stimulat- 
ing ointment  is  used.  Escharotics  are  employed  to  destroy 
morbid  growths,  warts,  polypi,  condylomata,  fungous  granu- 
lations, etc. ;  also  to  relieve  violent  inflammation  by  their 
substitutive  action  ;  to  stimulate  mdolent  ulcers,  sinuses,  etc. ; 
to  open  abscesses  of  the  liver,  and  other  internal  viscera,  the 
method  of  "  aspiration "  being  preferred ;  to  remove  cancer, 
lupus  and  other  morbid  growths ;  to  decompose  the  virus  of 
rabid  and  venomous  animals,  and  of  chancres  and  malignant 
pustules,  and  prevent  their  absorption. 

Escharotics  include  such  agents  as  caustic  potassa,  fused 
nitrate  of  silver,  caustic  soda,  solution  of  nitrate  of  mercury, 
corrosive  chloride  of  mercury,  bichromate  of  potassium,  the 
mineral  acids,  sulphate  of  copper,  and  the  substances  before 
referred  to. 

DEMULCENTS. 

Demulcents,  also  called  Lenitives,  are  medicinal  substances 
which  soften  and  relax  the  tissues.  When  applied  to  irritated 
or  inflamed  surfaces  these  agents  diminish  the  heat,  tension 
and  pain.  They  consist  principally  of  gum  or  mucilage,  often 
combined  with  saccharine  or  farinaceous  substances,  and, 
diluted  with  water,  form  viscid  solutions.  By  modifying  the 
acridity  of  the  secretions,  they  are  capable,  to  some  degree  at 
least,  of  relieving  irritation  in  remote  organs,  although  their 
constitutional  effects  are  chiefly  nutritive.  Demulcents  are 
employed  internally  to  protect  the  gastro-enteric  surface  from 
irritating  substances,  especially  poisons  of  an  acrid   nature ; 


REMEDIAL   AGENTS.  I49 

also  to  relieve  irritation  and  inflammation  of  the  alimentary- 
canal  in  such  affections  as  diarrhoea,  dysentery,  enteritis,  gas- 
tritis, etc.;  also  in  catarrhal  affections,  for  their  soothing  and 
lubricating  effects  from  direct  contact,  and  also  by  reflex 
action;  and  they  also  exert  some  influence  in  modifying  the 
acridity  of  expectorated  matters ;  also  in  such  affections  of 
the  urinary  passages  as  cystitis,  ardor  urinae,  as  they  tend  to 
diminish  the  acridity  of  the  secretions  :  also  as  drinks,  to  pro- 
mote the  action  of  the  secreting  and  exhaling  organs,  and  to 
allay  the  thirst  in  fevers  :  also  as  light  diet,  and  to  suspend 
substances  insoluble  in  water.  • 

Demulcents  are  employed  externally  in  the  form  known  as 
Emollients ,  to  relieve  the  heat,  swelling  and  pain  of  inflamma- 
tion, wounds  and  burns ;  to  hasten  suppuration,  as  deter- 
gents, to  cleanse  foul  ulcers,  and  to  promote  suppuration  from 
granulating  surfaces.  Mixed  with  water  in  the  form  of  soft 
masses,  they  are  commonly  termed  calaplasins  or  poultices, 
and  have  the  effect  of  softening  the  parts  to  which  they  are 
applied  as  vehicles  of  heat  and  moisture.  Included  in  the 
class  of  demulcents  are  such  substances  as  gum  arable,  flax 
seed,  tragacanth,  slippery-elm  bark,  sassafras  pith,  marshmal- 
low,  benne,  quince  seed,  liquorice  root,  Iceland  moss,  Irish 
moss,  starch,  arrow  root,  tapioca,  sago,  barley  glycerin,  pyr- 
oxylon,  collodion,  solution  of  gutta  percha,  honey,  animal 
fats,  such  as  lard,  in  the  form  of  cierate  (lard  2  parts,  and  white 
wax  I  part),  and  suet,  both  containing  stearine. 

ANTHELMINTICS. 

Anthelmintics,  or  Vermifuges,  are  medicinal  substances  em- 
ployed to  destroy  and  expel  worms  (entozoa)  from  the  alimen- 
tary canal.  Their  action  differs  according  to  the  nature  of 
the  substance  used,  either  to  destroy  by  a  direct  poisonous 
influence  or  by  mechanical  means.  The  most  powerful  of  the 
cathartics  (drastic^  also  acts  as  anthelmintics  by  the  copious 
secretion  and  exhalation  which  they  produce  from  the  alimen- 
tary canal.  When  anthelmintics  are  employed,  they  must  be 
persevered  in  for  several  days,  with  the  occasional  intervention 
of  an  active  cathartic. 


150 


DENTAL   MEDICINE. 


Belonging  to  this  class  are  such  agents  as  wormseed,  spi- 
gelia,  santonica,  cowhage,  male  fern,  oil  of  turpentine,  kameela, 
pumpkin  seed,  kousso,  calomel  with  gamboge,  calomel  with 
pink  root,  iron  preparations,  etc.,  etc. 

COLORING  AGENTS. 

Coloring  agents  are  substances  employed  to  communicate 
their  peculiar  color  to  pharmaceutical  preparations.  They 
include  saffron,  cochineal,  red  saunders,  etc.,  etc.;  and  in  dental 
practice  they  are  used  for  coloring  dentifrices,  such  as  rose  pink. 


In  addition  to  the  general  classes  mentioned,  there  are  cer- 
tain sub-classes  recognized,  which  have  not  been  specially 
referred  to  in  the  preceding  definitions,  as  follows : — 


Absorbents, 

Anodynes, 

Antemetics, 

Anthridrotics, 

Antiperiodics, 

Antipyretics, 

Antiseptics, 

Arotaatic  Bitters, 

Carminatives, 

Caustics, 

Cauterants, 

Constringents, 

Counter-irritants, 

Desiccatives, 


Detergents, 

Deodorizers, 

Diluents, 

Discutients, 

Disinfectants, 

Emollients, 

Errhines, 

Escharotics, 

Expectorants, 

Evacuants, 

Excitants, 

Febrifuges, 

Germicides, 

Haemostatics, 


Hypersthenics, 

Hypnotics, 

Laxatives, 

Nervines, 

Nutritives, 

Purgatives, 

Refrigerants, 

Resolvents, 

Restoratives, 

Sialogogues, 

Stimulants, 

Styptics, 

Vesicants. 


ABSORBENTS. 

Absorbents,  known  also  as  Desiccatives,  are  medicinal  agents 
capable  of  checking  secretions,  and  drying  up  secretions  or 
discharges  from  ulcers  and  suppurating  wounds.  Included  in 
this  class  are  tannic  acid,  oxide  of  zinc,  charcoal,  subnitrate  of 
bismuth,  starch,  powdered  galls,  magnesia,  powdered  myrrh, 
carbonate  of  lime,  etc.,  etc. 

ANODYNES  OR  ANALGESICS. 

Anodynes,  which,  with  sedatives,  hypnotics,  or  soporifics,  are 
included  in  the  group  of  narcotics,  are  medicinal  agents  capa- 
ble of  alleviating   pain    by  lessening  the    sensibility  of  the 


REMEDIAL   AGENTS,  151 


nerve-centres  or  the  peripheral  extremities.  When  applied 
locally  they  are  called  analgesics.  Included  in  this  class  are 
opium,  morphia,  chloroform,  sulphuric  ether,  aconite,  croton, 
chloral,  belladonna,  camphor,  gelsemium,  cannabis  indica, 
stramonium,  hyoscyamus,  carbolic  acid,  atropine,  creasote,  co- 
caine, eugenol,  iodoform,  iodol,  antipyrin,  blood-letting,  heat 
and  cold,  acupuncture,  etc.,  etc. 

ANTEMETICS. 

Antemetics  are  medicinal  agents  capable  of  arresting  vomit- 
ing. Included  in  this  class  are  creasote,  dilute  hydrocyanic 
acid,  lime  water,  chloral,  chloroform,  magnesia,  dilute  nitric 
acid,  dilute  phosphoric  acid,  belladonna,  oxalate  of  cerium,  etc. 

ANTHRIDROTICS. 

Anthridrotics  are  medicinal  agents  capable  of  checking 
perspiration.  Included  in  this  class  are  oxide  of  zinc,  sul- 
phuric acid,  acetic  acid,  tannic  acid,  sulphate  of  iron,  haema- 
toxylon,  etc. 

ANTIPERIODICS. 

Antiperiodics  are  medicinal  agents  capable  of  relieving 
periodical  diseases,  such  as  intermittent  fevers,  neuralgia,  etc. 
Included  in  this  class  are  cinchona,  quinia,  arsenic  (in  form  of 
Fowler's  solution),  chloroform,  chloride  of  soda,  salicin,  etc. 

ANTIPYRETICS. 

Antipyretics  are  medicinal  agents  having  a  decided  power 
to  depress  the  temperature  of  the  body  during  fever,  and  con- 
trol hyperpyrexia.  Included  in  this  class  are  antifebrin,  anti- 
pyrin, quinoline  or  chinoline,  thalline,  kairine,  camphor,  euca- 
lyptol,  hydroquinon,  pyrodin,  resorcin,  quinine,  salicine,  thymol, 
salol,  etc. 

ANTISEPTICS. 

Antiseptics  are  medicinal  agents  capable  of  arresting  fer- 
mentative processes,  preventing  the  development  of  bacteria, 
thereby  preventing  or  arresting  the  decomposition  of  organic 
substances,  and  the  process  of  putrefaction.  When  these 
agents  are  brought  in  contact  with  disease  germs  they  destroy 
their  vitality.    Included  in  this  class  are- carbolic  acid,  creasote. 


152  DENTAL  MEDICINE. 


salicylic  acid,  eucalyptus  oil,  iodoform,  benzoic  acid,  boracic 
acid,  pepsin,  bromine,  iodol,  hydronapthol,  peroxide  of  hydro- 
gen, pyrozone,  aristol,  bichlorideof  mercury,  essential  oils,  etc. 

Forms  of  Antiseptics  for  Use :  Dr.  Black  on  this  subject  says  : 
"  In  regard  to  the  use  of  antiseptics  in  different  cases  and  for 
different  purposes,  I  should  divide  them  into  three  forms,  each 
of  which  has  especial  advantages. 

"  These  forms  are :  the  solution  in  water,  the  oil,  and  the 
powder. 

"  The  solution  in  water  is  especially  useful  for  cleaning  in- 
fected surfaces  of  wounds,  washing  abscesses,  and,  indeed,  in 
any  case  where  there  is  something  that  can  be  removed  by 
washing.  In  the  performance  of  this  act  the  antiseptic  is  dif- 
fused to  all  parts  of  the  wound  or  abscess  mechanically  to  the 
best  advantage.  It  is  more  likely  to  reach  every  part  in  this 
form  than  in  any  other;  and  this  is  an  advantage  that  can 
hardly  be  overestimated  ;  for  it  is  very  difficult  to  reach  all 
parts  of  an  abscess  by  any  mode  of  procedure  now  known  to 
us  on  account  of  the  very  tardy  diffusion  of  liquids.  And  in 
case  the  liquid  containing  the  antiseptic  in  solution  does  dif- 
fuse, its  very  diffusion  and  mixture  with  the  surrounding  fluids 
soon  dilutes  it  below  its  range  of  antiseptic  value.  It  is  there- 
fore necessary  that  the  washing  be  continuous  to  obtain  the 
continuous  effect  of  the  drug.  This  is  generally  impracticable, 
and  for  this  reason  the  watery  form  of  antiseptics  is  very  much 
limited  in  usefulness.  The  continuous  drip,  or  the  application 
as  often  as  every  fifteen  or  twenty  minutes,  gives  effective  re- 
sults in  some  favored  localities  ;  but  it  is  very  difficult  to  carry 
out  and  occasions  much  trouble.  The  continuous  bath  is 
still  more  limited  in  its  range  of  application.  Neither  of  these 
can  be  used  in  dental  practice.  With  us  the  watery  form  of 
antiseptics  should  be  limited  to  the  cleaning  of  infected  parts. 
They  cannot  be  trusted  to  prevent  septic  action  for  any  length 
of  time,  for  the  reason  that  they  so  soon  become  diluted  be- 
low their  range  of  antiseptic  value  by  mixing  with  the  secre- 
tions, or  the  juices  of  the  flesh.  Since  studying  the  powers  of 
antiseptics  and  disinfectants  more  closely,  my  feeling  is  that  it 


REMEDIAL  AGENTS.  153 


will  not  do  for  us  to  expect  to  do  much  disinfectant  work  in 
connection  with  the  soft  tissues  except  in  cases  in  which  some 
tissue  destruction  can  be  borne ;  and  that  antiseptics  only  re- 
tard the  growth  of  microbes  during  their  presence  in  effective 
proportion ;  hence  the  necessity  for  continuous  and  oft-re- 
peated application.  In  using  these  for  the  purpose  of  clean- 
ing, much  aid  may  be  had  by  making  use  of  the  solution  in 
peroxide  of  hydrogen  instead  of  water,  so  as  to  obtain  the  • 
mechanical  effect  of  the  ebullition  of  the  oxygen  evolved  in  mix- 
ing the  antiseptic  with  the  secretions.  There  is  possibly  some 
antiseptic  virtue  in  oxygen  itself  as  well;  but  I  am  apt  to  think 
that  its  principal  use  is  the  mechanical  one.  And  that  is  a 
very  important  use.  Thorough  cleaning  is  excellent  antiseptic 
work,  and  the  peroxide  of  hydrogen  will  do  this  in  many 
positions  where  nothing  else  will,  and  at  the  same  time  carry 
the  antiseptic  proper  to  the  more  remote  parts  of  the  wound 
or  abscess." 

Sir  Joseph  Lister  is  the  originator  of  the  antiseptic  treat- 
ment in  surgery.  He  first  employed  carbolic  acid  as  an 
antiseptic  for  surgical  dressings,  but  abandoned  it  on  account 
of  its  slow  action  as  a  germicide  and  its  volatility.  He  then 
employed  bichloride  of  mercury,  which  was  stable  and  acted 
promptly,  but  caused  irritation,  and  was  precipitated  by  the 
albumen  contained  in  the  serum  of  the  blood.  He  then  em- 
ployed the  sero-sublimate  gauze,  consisting  of  gauze  saturated 
with  a  solution  of  bichloride  of  mercury,  in  the  serum  of  the 
blood ;  but  this  being  harsh  and  non-absorbent  he  substituted 
for  it  a  combination  of  chloride  of  ammonia  and  chloride  of 
mercury,  known  as  sal-alembroth,  which  was  not  only  less 
irritating,  but  was  soluble  in  blood  serum.  Later  he  presented 
the  double  cyanide  of  zinc  and  mercury  as  the  best  antiseptic, 
on  account  of  its  being  non-volatile,  un-irritating,  insoluble  in 
water,  and  only  soluble  in  3,000  parts  of  blood  serum,  with  an 
inhibitory  power  so  high  that  a  solution  of  i:i200  is  sufficient 
to  keep  animal  fluids  permanently  free  from  putrefaction.  The 
Listerian  method  consists  in  applying  over  the  line  of  the 
wound  six  or  eight  layers  of  the  gauze,  out  of  which  the  bi- 


154  DENTAL   MEDICINE. 


chloride  has  been  washed  by  wringing  it  out  once  or  twice  in 
a  solution  of  i  to  20  carbolic  acid.  All  zymotic  diseases  are 
at  the  present  time  generally  attributed  to  bacteria  or  to  their 
ptomaines,  and  for  a  number  of  years  the  theory  that  all  con- 
tagious and  epidemic  diseases  are  caused  by  micro-organisms 
has  been  received  by  the  medical  profession.  Many  diseases 
are  now  regarded  as  contagious  which  were  not  so  considered 
before  the  discovery  of  bacteria.  Bacteria  are  found  in  great 
numbers  and  different  varieties  in  the  air,  earth,  water,  and  in 
every  part  of  the  body  of  man  and  animals,  and  multiply  very 
rapidly  by  division  and  by  spores.  Some  varieties  are  subject 
to  change,  others  appear  to  be  permanent.  New  varieties  are 
supposed  to  be  produced  by  the  same  laws  by  which  the  dif- 
ferent kinds  of  vegetables,  plants  and  animals  are  generated. 
The  discoveries  in  bacteriology  have  brought  about  a  revolu- 
tion in  the  treatment  of  many  diseases,  namely,  tuberculosis — 
as  the  Koch  treatment — typhoid  and  other  fevers,  carbuncle, 
erysipelas,  diphtheria,  pneumonia,  influenza,  malaria,  tetanus, 
etc.,  etc.     (See  Use  of  Antiseptics  in  Dental  Practice)) 

AROMATIC  BITTERS. 

Aromatic  bitters  differ  from  simple  bitters  in  the  aromatic 
constituents  they  contain.  They  possess  tonic  properties  and 
invigorate  digestion  and  promote  constructive  metamorphosis. 
They  are  employed  in  the  same  cases  as  simple  bitters,  but 
appear  to  possess  some  specific  properties  due  to  the  aromatic 
constituents.  Included  in  this  class  are  serpentaria,  prunus 
virginiana,  canella,  anthemis,  etc. 

CARMINATIVES. 

Carminatives  are  medicinal  agents  capable  of  dispelling 
flatulence,  and  allaying  pain  in  the  stomach  and  bowels.  In- 
cluded in  this  class  are  such  agents  as  cinnamon,  cardamom, 
cloves,  coriander,  lavender,  juniper,  ginger,  caraway,  pepper- 
mint, etc. 

CAUSTICS. 

Caustics  are  medicinal  substances  capable  of  destroying 
vitalized  tissue.     (See  Irritants^ 


REMEDIAL   AGENTS.  155 


CAUTERANTS  (See  Irritants). 
CONSTRINGENTS  (See  Astringents). 

COUNTER-IRRITANTS. 

Counter-irritants  are  medicinal  agents  which  are  employed 
to  produce  external  irritation  for  the  purpose  of  relieving  or 
curing  diseased  action  in  another  part,  as  in  periodontitis,  for 
example,  when  such  agents  as  iodine,  cantharidal  collodion, 
creasote  and  iodine,  aconite  and  iodine,  ammonia,  etc.,  etc., 
are  applied  to  the  gum  over  the  root  of  the  affected  tooth. 
(See  Irritants.) 

DESICCATIVES. 

Desiccatives  are  medicinal  agents  capable  of  checking  secre- 
tions, and  arresting  mucous  discharges  from  ulcers,  wounds, 
etc.     (See  Absorbents^ 

DETERGENTS. 

Detergents  are  medicinal  agents  capable  of  cleansing 
ulcers,  suppurating  wounds,  etc.,  by  acting  as  either  stimu- 
lants or  emollients.  Included  in  this  class  are  such  agents 
as  borax,  burnt  alum,  slippery-elm  bark,  acacia,  flax  seed, 
tragacanth,  etc. 

DEODORIZERS. 

Deodorizers  are  medicinal  agents  capable  of  destroying 
infectious  and  fetid  odors.  Included  in  this  class  are  carbolic 
acid,  salicylic  acid,  creasote,  chloride  of  lime,  charcoal,  per- 
manganate of  potash,  thymol,  chloride  of  zinc,  solution  of  chlo- 
ride of  soda,  oil  of  eucalyptus,  iodoform,  menthol,  hydrochloric 
acid,  nitric  acid,  sulphuric  acid,  etc.,  etc.     (See  Antiseptics^j 

DILUENTS. 

Diluents  are  medicinal  agents  capable  of  diluting  the  blood 
and  thus  increasing  its  fluidity ;  at  the  same  time  exercising 
a  solvent  action  and  eliminating  a  portion  of  the  solid  con- 
stituents. Included  in  this  class  are  such  agents  as  water, 
aerated  water,  mineral  waters,  rice  water,  beef  tea,  whey, 
barley  water,  gruel,  etc.,  etc. 

DISCUTIENTS. 

Discutients  are  medicinal  agents  capable  of  reducing  and 
depressing  morbid  growths,  swellings,  etc.     Included  in  this 


156  DENTAL   MEDICINE. 


class  are   iodine,  mercury,  bromide   of  potassium,   iodide  of 
potassium,  chlorate  of  potassium,  arsenic,  colchicum,  etc.,  etc. 

DISINFECTANTS. 

Disinfectants  are  medicinal  agents  capable  of  depriving 
effluvia  of  their  morbific  properties  by  chemically  combining 
with  them.  Included  in  this  class  are  such  agents  as  chlorine, 
carbolic  acid,  carbolate  of  lime,  chloride  of  lime,  salicylic  acid, 
solution  of  chlorinated  soda,  charcoal,  creasote,  hydrochloric 
acid,  sulphuric  acid,  nitric  acid  and  chloride  of  zinc.  (See 
Antiseptics  and  Deodorizers^ 

EMOLLIENTS. 

Emollients,  or  Protectives,  are  medicinal  agents  capable  of 
relaxing  soft  tissues,  allaying  irritation,  protecting  sensitive 
surfaces,  relieving  pain  in  ulceration  of  mucous  membrane. 
Included  in  this  class  are  glycerine,  collodion,  solution  of  gutta 
percha,  acacia,  tragacanth,  Irish  moss,  sassafras  pith,  flax  seed, 
slippery-elm  bark,  liquorice  root,  wax,  in  the  form  of  cerate 
ointment,  poultices  of  bread  and  milk,  yeast  and  flax  seed,  and 
charcoal  and  yeast  with  flax  seed,  lard,  etc.,  etc. 

ERRHINES. 

Errhines  are  medicinal  agents  capable  of  inducing  a  secre- 
tion from  the  nose.  Included  in  this  class  are  ammonia,  ipe- 
cacuanha, chlorine,  acetic  acid,  orris  root,  etc.,  etc. 

ESCHAROTICS. 

Escharotics  are  medicinal  agents  capable  of  producing  an 
eschar  or  slough,  and  are  included  among  Irritants.  (See 
Irritants.) 

EXPECTORANTS. 

Expectorants  are  medicinal  agents  capable  of  promoting 
the  excretion  of  mucus  and  other  fluids  from  the  air  passages 
and  lungs.  Included  in  this  class  are  squill,  ipecacuanha,  ben- 
zoic acid,  preparations  of  ammonia,  tartar  emetic,  balsam  of 
tolu,  myrrh,  nitrate  of  potash,  seneca,  wild  cherry  bark,  lobe- 
lia, etc.,  etc.     (See  Blennorrlietics^ 


REMEDIAL  AGENTS.  157 

EVACUANTS. 

Evacuants  belong  to  the  class  of  cathartics  which  promote 
alvine  evacuations.     (See  Cathartics^ 

EXCITANTS. 

Excitants  belong  to  the  class  of  stimulants  which  excite  the 
vital  powers,  causing  an  increase  of  the  circulation.  (See 
Stiimdants?) 

FEBRIFUGES  OR  ANTIPYRETICS. 

Febrifuges  are  medicinal  agents  capable  of  diminishing  the 
heat  and  allaying  the  thirst  of  fevers,  and  are  generally  recog- 
nized as  Refrigerants.  Included  in  this  class  are  nitrate  of 
potassa,  chlorate  of  potassa,  the  mineral  acids,  spirits  of  nitrous 
ether,  antipyrin,  chinoline,  salicin,  etc.,  etc. 

GERMICIDES. 

Germicides  include  all  substances  which  destroy  any  form 
of  microbe  or  disease  germs,  such  as  bacteria,  which  are  inim- 
ical to  life.  Included  in  this  class  are  bichloride  of  mercury, 
peroxide  of  hydrogen,  iodoform,  iodol,  iodine,  salicylic  acid, 
eucalyptus,  carbolic  acid,  chlorine,  chloride  of  zinc,  permanga- 
nate of  potash,  naphthol,  etc. ;  also  heat. 

HEMOSTATICS. 

Hjemostatics  are  medicinal  agents  capable  of  arresting 
hemorrhage,  and  belong  to  the  class  of  Astringents.  (See 
Astringents  and  Styptics.) 

HYPERSTHENICS. 

Hypersthenics  belong  to  the  class  of  stimulants.  (See 
Stiimdants.) 

HYPNOTICS. 

Hypnotics  belong  to  the  class  of  Narcotics,  and  are  capable 
of  causing  sleep.     (See  Narcotics.) 

LAXATIVES. 

Laxatives  are  mild  cathartics.     (See  Cathartics) 


158  DENTAL   MEDICINE. 


NERVINES. 

Nervines  belong  to  the  class  of  Neurotics,  and  are  capable  of 
relieving  and  curing  disorders  of  the  nerves.     (See  Neurotics) 

NUTRITIVES. 

Nutritives  are  medicinal  agents  capable  of  quickening  as- 
similation and  building  up  the  organic  tissues.  Included  in 
this  class  are  cod-liver  oil,  gum  arable,  glycerin,  beef  extracts, 
milk,  manna,  etc.,  etc. 

PURGATIVES. 

Purgatives  are  active  cathartics,  and  are  divided  into  sev- 
eral classes,  according  to  the  nature  of  their  action,  such  as : 
Laxatives,  which  incite  intestinal  movements  without  much 
increase  of  the  intestinal  secretions.  Included  in  this  class 
are  manna,  sulphur,  magnesia,  castor-oil,  etc.  Saline  Purga- 
tives, which  produce  increased  secretion,  and  at  the  same 
time  hastens  the  peristaltic  action,  the  stools  being  loose  and 
watery.  Included  in  this  class  are  sulphate  of  magnesia, 
phosphate  of  soda,  tartrate  of  potassium  and  sodium,  Seidlitz 
powder,  bitartrate  of  potassium,  etc.  Mercurial  Purgatives, 
principally  calomel  and  blue  mass,  which  are  supposed  to 
produce  cholagogue  effects,  and  also  an  influence  peculiar  to 
themselves.  Tonic-astringent  and  resin-bearing  pitrgatives, 
which  have  an  influence  over  the  liver  and  the  glandular  ap- 
pendages, and  promote  the  tonicity  of  the  muscular  layer  of 
the  intestines.  Included  in  this  class  are  senna,  rhubarb, 
aloes,  jalap,  scammony,  colocynth,  podophyllum,  etc,  Hydra- 
gogue  purgatives,  which  are  very  energetic  in  their  action,  in- 
crease the  glandular  secretions  and  cause  an  abundant  outward 
diffusion  to  such  a  degree  as  to  produce  very  watery  stools; 
and  also  excite  rapid  and  severe  peristaltic  movements.  In- 
cluded in  this  class  are  gambogia,  croton-oil,  elaterium,  etc. 
(See  Cathartics}) 

REFRIGERANTS. 

Refrigerants  are  medicinal  agents  which  are  capable  of 
diminishing  heat  and  allaying  thirst.  They  are  also  called 
Febrifuges.     Included   in   this    class  are   nitrate    of  potassa, 


REMEDIAL  AGENTS.  159 

chlorate  of  potassa,  solution  of  acetate  of  ammonia,  acetic 
acid,  citric  acid,  hydrochloric  acid,  nitric  acid,  tartaric  acid, 
spirits  nitrous  ether,  etc.,  etc. 

RESOLVENTS. 

Resolvents  belong  to  the  classes  of  Alteratives  and  EmoU 
lients,  being  medicinal  agents  capable  of  reducing  inflamma- 
tion and  dispersing  morbid  swellings.  See  Alteratives  and 
Emollients. 

RESTORATIVES. 

Restoratives  belong  to  the  class  of  Stimulants  and  Tonics. 
(See  Stimulants  and  Tonics.) 

SIALAGOGUES. 

Sialagogues  are  medicinal  substances  capable  of  increasing 
the  salivary  secretion  by  a  stimulant  or  irritant  effect.  By  the 
excitant  properties  of  these  agents  the  lining  membrane  of  the 
mouth  is  irritated,  the  effect  extending  along  the  ducts  to  the 
salivary  glands,  so  that  not  only  is  the  quantity  of  fluid  exhaled 
from  the  mucous  membrane  increased,  but  salivation  results. 
In  this  way  depletion  follows  their  employment,  and  more  or 
less  revulsive  effect  ensues,  which  may  prove  beneficial  to 
distant  parts  affected  by  disease.  Sialagogues  may  also  prove 
useful  in  cases  of  paralysis  of  the  tongue,  etc.,  by  their  directly 
excitant  properties;  also  in  local  palsy  of  the  tongue.  They 
are  occasionally  employed  as  masticatories  in  odontalgia, 
and  in  such  affections  of  the  head  as  may  indicate  the  use  of 
substances  which  excite  irritation  in  and  increased  discharge 
from  the  lining  membrane  of  the  nasal  cavities.  Included  in 
this  class  are  pyrethrum,  horse  radish,  calamus,  ginger,  to- 
bacco, calomel,  corrosive  sublimate,  blue  mass,  iodide  of  mer- 
cury, etc. 

STYPTICS. 

Styptics  which  belong  to  the  class  of  Astringents  are  medi- 
cinal agents  capable  of  arresting  hemorrhage  when  employed 
externally.  They  are  divided,  according  to  their  action,  into 
chemical  diVid  mechanical,  \hQ  chtvmcA  styptics  coagulating  the 
blood  exuding  from  the  part,  and  at  the  same  time  stimulating 


160  DENTAL   MEDICINE. 


the  tissues  to  contraction;  whilst  the  mechanical,  as  lint,  felt, 
spider's  web,  plaster  of  Paris,  etc.,  detain  the  blood  in  their 
meshes,  or  absorb  it  until  it  coagulates,  and  thus  arrest  the 
hemorrhage.  Among  the  Astringents  which  may  be  classed 
as  Styptics  and  local  astringents  are  tannic  acid,  persulphate 
of  iron  solution,  powdered  subsulphate  of  iron,  alum,  nitrate 
of  silver,  powdered  galls,  sulphuric  acid,  matico,  gallic  acid, 
perchloride  of  iron,  catechu,  oak-bark,  rhatany,  etc.;  and  as 
mechanical  styptics,  collodion,  matico,  spider's  web. 

By  contraction  of  the  blood-vessels  internally:  digitalis  and 
ergot ;  also  for  checking  excessive  discharges :  acetate  of  lead, 
carbonate  of  lead,  subacetate  of  lead,  lime  water,  the  applica- 
tion of  cold  as  ice,  and  of  heat,  as  hot  water,  etc. 

VESICANTS. 

Vesicants,  which  belong  to  the  class  of  Epispastics,  are 
medicinal  agents  capable  of  producing  a  serous  exudation 
beneath  the  cuticle.  Included  in  this  class  are  cantharides, 
cantharidal  collodion,  glacial  acetic  acid,  strong  solution  of 
ammonia,  mustard,  etc.,  etc.     (See  Epispastics.) 

FORMS  IN  WHICH  MEDICINAL  SUBSTANCES  ARE  EMPLOYED. 

Alkaloids  are  bases  capable  of  combining  with  acids  to 
form  salts,  and  which  exist  as  proximate  principles  in  certain 
vegetables,  and  possess  the  properties  of  an  alkali  in  a  greater 
or  less  degree.  Alkaloids  are,  therefore,  the  active  principles 
of  medicines. 

Baths. — Medicinal  Baths  are  composed  of  tepid  water,  with 
the  addition  of  saline,  emollient,  narcotic  or  stimulant  sub- 
stances, such  as  salt,  mustard,  etc.,  etc. 

Cataplasms  are  poultices  or  plasters  composed  of  soft, 
macerated  preparations,  to  be  applied  externally. 

Collyria  are  preparations  applied  to  the  eyes.  They  are 
sometimes  dry,  but  generally  liquid,  consisting  of  infusions, 
decoctions  or  distilled  waters,  with  the  addition  of  various 
medicinal  substances. 

Confections,  or  Electuaries,  are  preparations  made  into  a 
pulpy  mass,  with  sugar  or  honey,  mucilage  or  glycerin. 


THERAPEUTIC  FORMS.  161 

Decoctions  are  solutions  made  by  boiling  certain  vegetable 
ingredients  in  a  fluid,  for  the  purpose  of  extracting  the  parts 
soluble  at  that  temperature. 

Emulsions  are  preparations  composed  of  oils,  resins,  etc., 
suspended  by  means  of  mucilage,  yolk  of  egg,  sugar,  etc. 

Enemata,  or  Clysters,  are  liquid  preparations  injected  into 
the  rectum  by  means  of  a  syringe,  as  auxiliaries  to  or  substi- 
tutes for  cathartics. 

Extracts  are  preparations  obtained  by  the  evaporation  of 
a  vegetable  solution,  in  the  form  of  juices,  infusions  or  decoc- 
tions, to  a  more  or  less  fluid  consistence. 

Fomentations  are  fluid  preparations  applied  to  the  surface 
of  the  body  by  means  of  a  sponge,  flannel  or  soft  cloth. 

Fumigations  are  the  vapors  of  medicinal  substances  em- 
ployed to  purify  infected  air  by  absorbing  or  otherwise  coun- 
teracting deleterious  gases.  They  are  also  employed  in  dis- 
eases of  the  skin,  and  may  be  sometimes  substituted  for  a 
local  bath. 

Gargles  are  washes  for  the  mouth  and  throat,  and  are  gen- 
erally astringent  and  stimulating,  sedative,  refrigerant,  etc.  To 
be  of  any  service,  gargles  or  mouth  washes  must  be  frequently 
applied  and  persevered  in  for  some  time.  They  are  employed 
in  cases  of  inflammation  and  ulceration  of  the  mucous  mem- 
brane of  the  mouth  and  fauces. 

Glycerites  are  solutions  of  medicinal  substances  in  gly- 
cerine. 

Infusions  are  preparations  obtained  by  pouring  a  hot  or 
cold  fluid  upon  vegetable  substances,  for  the  purpose  of  ex- 
tracting their  medicinal  properties. 

Inhalants  are  remedies  in  the  form  of  steam,  for  inhalation 
directly  to  the  lungs. 

Injections  are  medicated  fluids  thrown  into  a  natural  or 
preternatural  cavity  of  the  body  by  means  of  a  syringe. 

Liniments,  or  Embrocations,  are  unctuous  medicinal  prep- 
arations to  be  applied  externally  by  means  of  friction. 

Lotions  are  liquid  preparations  or  washes,  to  be  applied  to 
the  body  externally. 
11 


162  DENTAL   MEDICINE. 


Mixtures  are  fluid  preparations  containing  several  medici. 
nal  ingredients,  to  be  administered  by  the  mouth. 

Ointments,  or  Cerates,  are  preparations  of  the  consistence 
of  lard,  composed  of  wax,  lard,  or  resin,  with  solid  or  liquid 
ingredients,  for  topical  application.  Cerates  are  somewhat 
harder  than  ointments,  especially  where  wax  is  substituted  for 
the  lard. 

Oleates  are  medicinal  ointments.    (See  Medicinal  Oleates). 

Pills  are  simple  or  compound  medicinal  agents,  of  a  firm 
consistence,  spherical  or  globular  in  shape,  and  generally  not 
exceeding  five  or  six  grains  in  weight. 

Plasters  are  preparations  of  a  solid  glutinous  composition, 
which,  at  the  ordinary  temperature  of  the  body,  adheres  to 
the  part  on  which  it  is  placed. 

Poultices  are  preparations  for  applying  continuous  heat 
and  moisture  and  softening  the  tissues.  Their  effects  are  to 
cause  an  afflux  of  blood  to  the  part,  dilate  the  vessels  and 
soften  the  tissues  by  the  influence  of  both  heat  and  moisture, 
and  render  the  diffusion  of  the  fluids  easy.  In  inflammatory 
conditions,  the  stasis  of  the  vessels  implicated  is  relieved,  the 
tension  of  the  parts  lessened  and  resolution  brought  about. 
Where  the  stage  of  exudation  is  present,  these  preparations 
promote  the  increase  and  migration  of  the  white  corpuscle, 
and  facilitate  the  escape  of  purulent  matter.  Poultices  also 
relieve  the  pain  of  inflamed  parts  by  relaxing  the  tissues,  and 
thereby  removing  pressure  from  the  sensory  nerve  filaments  ; 
they  relieve  pain  in  parts  distant  from  the  points  where  their 
applications  are  made,  and  have  both  a  local  and  systemic 
effect.  Poultices  are  generally  composed  of  such  substances 
as  flaxseed-meal,  powdered  slippery-elm  bark  and  corn  meal ; 
also  bread  and  milk  are  sometimes  employed. 

The  substance  dissolved  in  hot  water  is  spread  upon  soft 
muslin  of  such  a  size  as  to  allow  one  free  end  to  fold  over  the 
mass  and  intervene  between  it  and  the  surface  of  the  skin ;  or 
it  may  be  inclosed  in  a  small  bag  of  muslin.  Glycerine  spread 
over  the  surface  of  a  poultice  will  prevent  its  drying.  Lauda- 
num is  often  added  to  mitigate  the  pain,  if  necessary;  also 


THERAPEUTIC   FORMS.  1G3 

charcoal  in  the  form  of  powder.  A  yeast  poultice  is  made  of 
brewer's  yeast  with  enough  of  flaxseed  to  give  it  a  proper  con- 
sistence. They  should  not  be  allowed  to  remain  too  long,  as 
their  effect  will  cause  the  skin  to  become  white,  wrinkled  and 
pulpy,  and  lead  to  the  formation  of  small  boils  or  abscesses ; 
also,  in  case  of  wounded  or  ulcerated  surfaces,  their  too  long 
use  will  cause  the  granulations  to  become  pale  and  flabby  and 
prevent  healing;  be?ides,  if  the  granulations  are  large,  they 
lower  the  tone  and  vigor  of  the  system,  depress  the  circulation, 
and  exhaust  the  irritability  of  the  vaso-motor  nerves,  and 
thus  prevent  healing.  Poultices  are  employed  in  boils,  car- 
buncles, irritable  ulcers,  gangrenous  sloughs.  The  charcoal 
and  yeast  poultices  are  used  iij  foul  wounds.  Poultices  are 
also  applied  with  benefit  in  pneumonia,  pleuritis,  pericarditis, 
hepatitis,  peritonitis,  faucial  inflammation,  etc. 

Suppositories  are  solid  preparations,  of  a  round,  cylindrical, 
or  conical  form,  to  be  introduced  into  the  anus ;  and  are  com- 
posed of  sedative,  astringent,  or  purgative  medicines,  com- 
bined with  suet,  cocoa-butter,  honey  or  soap. 
•  Syrups  are  liquid  conserves,  made  by  dissolving  sugar  with 
some  plant,  or  in  water,  either  with  or  without  medicinal  im- 
pregnation. 

Tinctures  are  preparations  in  the  form  of  solutions  of  the 
active  portions  of  medicinal  substances,  in  rectified  or  proof 
spirits.  A  tincture  is  called  simple  when  it  holds  only  one 
substance  in  solution,  and  compoiind,  when  two  or  more  ingre- 
dients are  submitted  to  the  solvent. 


DENTAL    MATERIA    MEDICA 

AND 

THERAPEUTICS. 


ACACIA- GUM   ARABIC. 

Source. — A  thorny  tree  or  shrub,  of  Arabia  and  Africa. 

Description. — The  concrete  juice  which  exudes  spontaneously 
from  the  stem  of  the  Acacia  vera,  in  the  form  of  a  gum,  which 
hardens,  on  exposure,  in  smal^,  irregular  or  roundish  or  oval 
pieces,  of  various  sizes,  more  or  less  transparent,  hard,  brittle 
and  pulverizable.  It  is  generally  either  white  or  yellowish 
white,  but  sometimes  of  a  deep  orange  or  brownish  color;  the 
powder,  however,  being  pure  white.  It  is  inodorous,  with  a 
feeble,  slightly  sweetish  taste,  and  when  pure  dissolves  wholly 
away  in  the  mouth. 

In  water  it  forms  a  viscid  solution,  known  as  mucilage. 

It  is  insoluble  in  alcohol,  ether  and  the  oils.  When  kept 
dry  it  undergoes  no  change. 

Chemical  Constituents. — It  consists  of  a  peculiar  proximate 
principle  known  as  Gum  or  Arabin,  composed  chiefly  of  a 
soluble  acid  s\xhstdiX\c&,  Gummic  Acid  [Yi^Ci^Yii^OyQ^H^O),  com- 
bined  with  3  per  cent,  of  lime,  forming  a  soluble  salt,  gummate 
of  calcium. 

Medicinal  Properties  and  Action. — Demulcent  and  emollient. 
It  forms  an  excellent  adjunct  to  other  medicinal  substances  of 
the  same  class,  and  an  ingredient  in  all  the  officinal  lozenges. 

Dose. — Of  the  gum,  Sj  ad  libitum.  Of  the  mucilage  (5iv, 
water  Svj)  oij  to  ovj  daily,  or  ad  libitum. 

Therapeutic  Uses. — Coughs  and  hoarseness,  gastro-intestinal 
irritation,  infantile  diarrhoea,  epistaxis  and  superficial  hemor- 
rhages ;  applied  in  the  form  of  fine  powder. 

Dental  Uses. — As  an  emollient,  in  the  form  of  mucilage,  to 
cover  and  protect  inflamed  surfaces  of  mucous  membrane. 
164 


ANTIFEBRINE  165 


As  a  mechanical  styptic,  in  a  finely-powdered  form,  in  super- 
ficial hemorrhages,  such  as  fi-om  leech  bites,  etc. 

Combined  with  borax,  it  is  a  useful  application  for  inflamed 
mucous  membrane. 

Prof  Bonafoux  of  the  Academy  of  Medicine,  Paris,  recom- 
mends a  powder  composed  of  equal  parts  of  gum  arabic,  colo- 
phony and  carbon,  as  possessing  great  haemostatic  powers,  and 
capable  of  arresting  the  bleeding  of  large  arteries. 

DENTAL  FORMULA. 

'  For  Inflamed  Mucotts  Surfaces. 

R,         Pulveris  acacise t^ij 

Sodii  boratis 3  ij 

Fiat  pulvis 
SiG. — Apply  to  inflamed  part. 

ACETANILIDE— /'iY^TV^FZ-^  CE  TAMIDE  (ANTIFEBRINE). 

Fonnula.—Q^^'^O  or  CeH^N  (C2H3O)  H. 

Derivation. — Acetanilide  is  a  derivative  of  aniline,  made  by 
adding  an  excess  of  glacial  acetic  acid  to  pure  colorless  ani- 
line. It  is  in  the  form  of  a  white  crystalline  powder  of  neutral 
reaction,  without  odor  or  disagreeable  taste,  slightly  pungent, 
producing  a  burning  sensation  when  applied  to  the  tongue.  It 
resembles  "  mother  of  pearl  "  when  evaporated  by  heat,  in  the 
form  of  large  scales.  It  is  but  slightly  soluble  in  cold  water, 
but  freely  soluble  in  ether,  chloroform  and  alcoholic  solutions. 
It  is  not  altered  by  acids  or  alkalies.  The  pure  drug  should 
be  white  or  of  a  faint  rose-tint,  and  should  form  a  colorless 
liquid  and  completely  volatilize  when  heated  upon  a  platinum 
surface.  Water  of  a  temperature  of  105°  F.  will  dissolve  one 
part  of  it  to  fifty  of  the  water ;  alcohol,  from  3  to  5  parts,  and 
ether  and  chloroform  in  larger  proportions. 

Therapeutic  Action  and  Properties. — Acetanilide  is  antipy- 
retic, diuretic,  antiperiodic  and  anodyne,  and  in  ordinary  doses 
its  action  is  less  marked  on  healthy  persons  than  when  fever 
is  present,  as  its  most  apparent  action  is  to  reduce  temperature 
by  converting  oxyhaemoglobin  into  methasmoglobin  in  the 
red   blood-corpuscles   interfering  with  oxidation.     When  an 


166  DENTAL   MEDICINE. 


excessive  quantity  is  absorbed,  the  alkalinity  of  the  blood 
is  reduced,  the  red  corpuscles  destroyed,  the  haemoglobin 
liberated  and  appearing  in  the  urine,  which  is  changed  to  a  dark- 
brown  color.  It  increases  the  quantity  of  uric  acid  and  urea 
present  in  the  urine.  Large  doses  may  cause  diastolic  arrest 
of  the  heart,  preceded  by  motor  and  sensory  paralysis.  Small 
doses  increase  the  action  of  the  skin  and  kidneys.  The  blood- 
pressure  at  first  increases,  but  soon  falls,  and  the  heart's 
action  becomes  slower.  It  is  contraindicated  in  large  doses 
in  the  low  fevers,  owing  to  its  action  on  the  blood  cells.  It  is 
eliminated  by  the  kidneys.  Belonging  to  the  aromatic  series 
of  antipyretics,  derived  from  coal  tar,  it  possesses  advantages 
over  all  the  others  from  the  same  source.  In  some  cases 
toxic  effects,  ascribed  to  impurity,  or  peculiar  susceptibility  to 
its  action,  have  resulted  from  its  administration  ;  cyanosis  and 
collapse  also  have  occurred,  as  well  as  vomiting  and  profuse 
perspiration.  Such  ill  effects  from  acetanilide  must  be  coun- 
teracted by  the  application  of  external  heat,  vigorous  alcoholic 
stimulation,  with  hypodermic  use  of  ether,  atropine,  and 
strychnine,  in  order  to  support  the  respiration  and  circulation. 
Acetanilide  is  much  used  for  headache,  neuralgia,  rheumatism, 
facial  neuralgia,  locomotor  ataxia,  sciatica  ;  in  acute  inflam- 
matory rheumatism  it  reduces  the  temperature,  relieves  the 
pain  and  swelling.  It  is  also  used  in  croupous  pneumonia, 
scarlatina  and  other  febrile  affections  of  children. 

It  relieves  any  tendency  to  nausea  and  vomiting,  and  is 
usually  tolerated  by  a  weak  stomach.  On  account  of  its 
diuretic  action  acetanilide  is  especially  harmless  in  kidney 
affections. 

Dose. — The  dose  varies  from  grs.  ijss,  repeated  every  hour, 
to  grs.  X  every  three  or  four  hours  ;  it  may  be  given  in  the 
form  of  pill,  powder  or  tablet  trit"rate.  Its  prolonged  use 
causes  it  to  lose  its  effect;  but  its  action  is  renewed  if  the 
drug  is  withheld  for  24  or  48  hours. 

Dental  Uses. — Acetanilide  is  employed  in  dental  prac- 
tice for  facial  neuralgia,  pulpitis  ;  internally  administered  in 
connection  with  the  application  of  the  devitalizing  mixture  to 


ACETIC  ACID.  167 


relieve  the  pain  of  the  latter,  in  doses  of  two  and  one-half 
grains,  repeated  every  hour  until  ten  grains  have  been  taken  ; 
also  for  the  relief  of  the  pain  of  periodontitis  and  alveolar 
abscess,  etc.,  etc.  For  periodontitis,  first  paint  the  gum  over 
affected  root  with  tincture  of  aconite  and  tincture  of  iodine, 
equal  parts,  then  apply  a  capsicum  plaster  to  gum,  and  admin- 
ister two  and  one-half  grains  of  acetanilide  ;  repeat  the  acetan- 
ilide,  if  necessary,  every  two  hours  until  ten  grains  are  taken. 
In  facial  neuralgia,  periodontitis,  etc.,  it  has  proved  effectual  in 
cases  where  quinine  has  failed,  or  has  been  contraindicated. 

DENTAL  FORMULA. 

For  Facial  Neuralgia,  Nettralgic  Head-  For  Simple  Fevers  of  Children. 

ache,  Acute  Periodontitis,  etc.  ^^    Hollopeter. 

Dr.  Shoemaker.  t,       a     .     mj 

li.     Acetanilide gr.xviij 

R.     Acetanilide     ....  gr.ioo  Hydrarg.  chlor.  mitis    .  gr.j 

Lupulini gr.ioo     M.  Sodii  bicarb gr.xij 

Ft. — Capsulse  No.  xx.  Sacch.  lact gr.xv. 

SiGNA. — One  or  two  capsules  every  2  or  M.  Ft. — Chart.  No.  xij. 

3  hours.  SiGXA. — One  every  2  hours  until  3  are 

taken. 

For  Pain  of  Pericementitis.  A    Convenient    Prescription  for  Ace- 

tanilide (Antifebrine). 
Dr.  a.  W.  Harlan.  ^       "^  ' 

Dr.  E.  L.  Clifford. 

R.     Acetanilide gr.viij  ^      Acetanilide.    .    .    .  3J 

Syr.  simple     .....  ^^^ij  Sp.  vini  gallici    .    .  giv.ss 

Spir.  frumenti    ,    .    .    .   3  ij.     M.  Syr.  simp 

Signa. — One-half  of    the   above    at    i  Aquje aa  z  vj.      M. 

time,  followed  in  5  hours  by  the  other  Signa.— A    tablespoonful    contains    5 

"^'i-  grains,  an  adult  dose. 

ACIDUM   ACETICUM— ACETIC  ACID. 
Fonnula. — CgH^Og,  or  conveniently  written  HCgHgOo- 
Derivation. — Purified   Pyroligneous  Acid.     Prepared    from 
wood  by  destructive  distillation;  contains  28  per  cent,  of  anhy- 
drous acetic  acid.     Specific  gravity,  1.047. 

Dilute  Acetic  Acid — Acidiim  Aceticiim  Dilututn,  the  only 
form  in  which  it  is  employed  internally,  is  prepared  by  mixing 
one  pint  of  acetic  acid  with  seven  pints  of  distilled  water. 
Specific  gravity,  I.006. 


168  DENTAL   MEDICINE. 


Medical  Properties  and  Action. — Refrigerant,  diaphoretic, 
astringent,  diuretic,  stimulant,  tonic.  It  allays  restlessness  by- 
allaying  thirst,  and  acts  upon  the  skin  and  kidneys ;  al^o  acts 
as  an  antiscorbutic.  The  strong  acid  applied  to  the  skin 
causes  intense  redness  and  pain,  followed  by  rapid  vesication. 

Dose. — Of  acetic  acid,  gtt.  iij  to  x.  Of  dilute  acetic  acid, 
5j  to  ij. 

Therapeutic  Uses. — Fevers,  night  sweats,  diarrhoea,  scurvy, 
hemorrhage  of  the  lungs,  stomach  and  nose.  Externally, 
the  strong  acetic  acid  is  applied  in  tinea  capitis,  psoriasis, 
cancer,  corns  and  warts  ;  the  dilute  form  is  applied  externally 
to  gangrene,  ulcerated  throat,  in  the  form  of  gargle,  ulcers, 
sprains  and  bruises.  Owing  to  its  volatility  and  pungency,  its 
vapor,  when  applied  to  the  nostrils,  acts  as  an  excitant  in 
syncope,  headache,  etc.  ' 

Dental  Uses. — Acetic  Acid  is  externally  employed  in  indo- 
lent ulcers  of  the  mouth,  cancrum  oris  and  scurvy,  both  locally 
and  internally.  It  is  also  applied  to  fungous  growths  of  gums 
and  dental  pulps,  the  stronger  acid  being  used.  In  the  form 
of  glacial  acetic  acid — Acidiitn  Aceticiini  Glaciale  (concentrated 
acetic  acid),  it  is  applied  externally,  as  a  caustic  in  fungous 
growths  of  gum,  dental  pulp,  etc.  In  cancerous  ulcerations  of 
mucous  membrane,  it  relieves  pain,  and  promotes  a  healthier 
condition. 

DENTAL  FORMULA. 

For    Indolent     Ulcers   of  the   Mouth,  For  Inflamed  Fauces. 

Cancrtim   Oris,  Scurvy. 

„  R.     Acidi  acetici   .    .  .    .  f%ij 

R.     Acidi  acetici      .    .    .    .  f  iiij  a            ■•    ,,     •■■•            „■ 

^   ■'  Ammonu  chloridi  .    .    gj 

^•1"^ ^^^-  Mellis fgiss 

Fiat  solution.  .  r       •• 

Aquse l^iai]. 

SiGNA. — Apply    with    a     camel's-hair  -c.-  ^ 

^•^  ■'  r\aX.  gargarysma, 

brush. 

ACIDUM   ARSENIOSUM— ARSENIOUS  ACID. 
WHITE  OXIDE  OF  ARSENIC-ARSENIOSUM  OXIDUM. 

Forniida, — AsgOg. 

Arsenic-arsenicum,  the    metal  from  which   arsenious   acid 
is  obtained,  is  not  employed  as  a  medicine  in  its  native  state. 


ARSENIOUS  ACID.  169 


It  is  combined  with  sulphur  and  certain  metals,  and  is  hard, 
brittle,  crystalline,  of  a  steel-gray  color.  When  heated  to  a 
dull  redness,  it  volatilizes  in  the  form  of  a  colorless  vapor,  with 
an  odor  like  that  of  garlic — alliaceous.  It  is  generally  found 
in  cobalt  ore.     It  is  a  powerful  poison. 

Derivation. — Arsenious  Acid  is  obtained  by  roasting  arseni- 
cal ores,  and  purifying  by  sublimation.  It  is  in  the  form  of  a 
fine  white  powder,  which  is  often  adulterated  with  chalk,  lime, 
etc.;  hence  it  is  better  to  procure  it  in  the  solid  form  or  lump, 
which  is  of  a  milk  white  color  externally,  and  often  perfectly 
transparent  internally.  It  has  no  odor,  and  is  therefore  liable 
to  be  mistaken  for  more  innocent  substances,  and  scarcely  any 
taste,  or  merely  a  faint,  sweetish  impression. 

Medical  Properties  and  Action. — Arsenious  Acid  in  large 
doses  is  a  virulent  irritant  poison,  but  in  doses  of  one-sixtieth 
to  one-twelfth  of  a  grain,  properly  administered,  is  a  tonic, 
increasing  the  appetite  and  improving  the  secretions,  both  in 
quality  and  quantity.  In  large  doses,  in  the  form  of  Fowler's 
Solution — Liquor  Potassii  Arsenitis  (prepared  by  boiling  64 
grains  of  arsenious  acid  and  bicarbonate  of  potassium,  each  in 
half  a  fluid  ounce  of  distilled  water,  then  adding  12  fluid 
ounces  more  of  distilled  water,  half  a  fluid  ounce  of  compound 
spirit  of  lavender,  and  afterward  water  enough  to  make  the 
solution  measure  a  pint) — it  is  a  powerful  antiperiodic.  In 
small  doses,  administered  for  a  considerable  time,  it  modifies 
the  blood,  and  through  it  nutrition,  so  as  to  remove  various 
morbid  conditions.  When  continuously  used,  a  sensation  of 
heat  in  the  throat,  oesophagus  and  stomach  is  sometimes  ex- 
perienced, nausea,  pain  in  the  stomach  and  occasional  vomit- 
ing; also,  great  languor  or  depression  of  spirits,  with  redness 
of  the  eyes,  swelling  of  the  eyelids  and  oedema  of  the  face; 
hence,  at  the  first  evidence  of  such  symptoms,  the  remedy 
should  be  discontinued  until  they  have  passed  away.  When 
continually  increasing  doses  are  administered,  the  arsenic 
accumulates,  and  poisonous  symptoms  quickly  appear;  hence, 
it  is  recommended  to  begin  a  course  of  arsenic  with  large  doses, 
and  the  quantity  given  regularly  reduced.     When  arsenious 


170  DENTAL  MEDICINE. 


acid  is  administered,  the  bowels  should  be  well  evacuated  by 
a  purgative,  given  previously,  and  the  arsenic  taken  directly 
after  a  meal,  but  never  upon  an  empty  stomach,  on  account  of 
gastric  irritation.  Its  use  should  be  omitted  for  a  day  or  two 
every  two  or  three  weeks,  and  a  mild  aperient  employed, 
in  order  to  prevent  the  accumulation  of  the  arsenic  in  the 
system.  A  few  drops  of  laudanum  added  to  the  arsenical 
preparation  will  prevent  nausea  and  vomiting.  All  arsenical 
preparations  should  be  administered  with  the  greatest  regu- 
larity, at  stated  times. 

During  the  employment  of  arsenic,  the  eyes  of  the  patient 
should  be  examined  daily,  and  if  the  eyelids  and  conjunctiva 
become  inflamed,  the  remedy  should  be  discontinued ;  also, 
when  the  urine,  from  being  pale  and  copious,  becomes  scanty, 
acid  and  high-colored,  the  arsenic  should  be  suspended. 

Poisonous  symptoms  have  been  caused  by  half  a  grain  of 
arsenious  acid,  and  fatal  effects  have  followed  the  administra- 
tion of  two  grains,  although  much  larger  quantities  have  been 
taken  with  impunity  ;  very  large  quantities  often  cause  emesis, 
which  removes  the  substance  from  the  stomach,  and  thus  pre- 
vents fatal  effects.  When  the  idiosyncrasies  of  the  patient 
are  unknown,  it  is  better  to  use  small  doses  before  beginning 
with  large  doses.  The  quantity  of  arsenic  required  to  pro- 
duce a  fatal  effect  varies  according  to  the  susceptibilities  of 
the  patient  and  the  state  of  the  stomach.  Much,  however, 
depends  on  the  idiosyncrasies  of  the  individual,  which  differ 
greatly  in  different  persons.  When  large  quantities  are  taken, 
the  effects  are  sometimes  manifested  on  the  cerebro-spinal 
system,  death  following,  from  narcotism,  in  a  short  time. 

The  amount  of  arsenious  acid  which  maybe  safely  intro- 
duced into  the  stomach  should  never  be  equaled  in  an  appli- 
cation to  the  pulp  of  a  tooth.  One-twentieth  of  a  grain  may 
be  a  safe  dose  medicinally,  but  a  much  less  quantity  is  suffi- 
cient for  devitalizing  the  pulps  of  teeth. 

When  arsenious  acid  is  swallowed  or  applied  to  a  denuded 
surface,  it  is  rapidly  absorbed  into  the  system;  hence  it  is  a 
dangerous  agent,  and  in  every  case  should  be  carefully  used, 


ARSENIOUS   ACID.  171 

and  its  effects  closely  watched.  It  possesses  a  very  powerful 
antiseptic  property,  arresting  the  process  of  putrefaction.  The 
stomach  and  alimentary  canal  of  persons  who  have  died  from 
its  effects  have  been  found  in  a  perfect  state  of  preservation 
for  a  long  time  after  interment. 

Poisonous  doses  produce  great  intestinal  inflammation,  with 
ulceration  in  some  cases,  and  rarely,  gangrene.  It  has  also 
been  detected  after  death,  in  the  blood,  in  the  urine,  and  also 
in  the  liver,  spleen,  kidneys,  muscles  and  stomach.  A  certain 
degree  of  tolerance  in  the  use  of  arsenic  may  be  established, 
where  poisonous  doses  can  be  taken  with  impunity.  Such  a 
state  may  be  produced  by  the  constant  legitimate  use  of  the 
agent,  or  in  the  case  of  those  who  begin  the  habit  of  arsenic 
eating  at  an  early  age,  and  who  find  this  practice  of  service  in 
increased  breathing  power,  strength,  and  improved  bodily 
condition.  As  long  as  such  a  habit  is  continued,  no  ill  effects 
are  apparent ;  but  as  soon  as  the  arsenic  is  discontinued,  symp- 
toms resembling  those  of  poisonous  doses  make  their  appear- 
ance. 

Arsenious  acid  acts  locally  as  an  escharotic,  but  while  a  true 
escharotic  acts  chemically,  producing  decomposition  of  the 
part  to  which  it  is  applied,  a  state  incompatible  with  life, 
arsenic  destroys  the  vitality  of  the  organized  structure,  and 
its  decomposition  is  the  consequence.  This  distinction  should 
be  remembered  in  the  use  of  arsenious  acid  in  dental  practice. 

Arsenic  is  eliminated  by  the  liver,  kidneys,  intestinal  canal 
and  bronchial  tubes  ;  and  it  is  thought  that  some  of  the  symp- 
toms produced  by  it  have  their  origin  in  the  local  effects  of 
the  poison  on  the  channels  of  excretion. 

The  symptoms  of  gastro-intestinal  arsenical  poisoning — the 
more  common  form — are  described  by  Bartholow  as  follows  : 
Burning  sensation  at  the  epigastrium,  and  extending  over  the 
abdomen;  violent  and  uncontrollable  vomiting;  excessive 
dryness  of  the  mouth  and  fauces,  intense  thirst,  intestinal  irrita- 
tion, bloody  and  offensive  stools,  retracted  abdomen,  strangury, 
suppression  of  urine,  or  bloody  urine,  and  in  females  menor- 
rhagia  ;  rapid  and  feeble  action  of  the  heart,  oppressed  breath- 


172  DENTAL  MEDICINE. 


ing,  great  agitation  and  restlessness,  shrunken  features,  cold 
breath,  involuntary  evacuations,  collapse  ;  consciousness  being 
retained  to  the  end. 

The  symptoms  of  the  cerebral  form  of  arsenical  poisoning 
are  profound  insensibility  and  coma,  similar  to  extreme  opium 
narcosis.  The  effects  of  arsenical  poisoning,  when  not  fatal, 
are  felt  for  a  longtime  in  the  form  of  gastro-enteric  irritability, 
an  irritable  condition  of  the  skin,  stiffness  of  the  joints,  neu- 
ralgic pains,  numbness,  formication,  paralysis,  etc. 

After  death  from  arsenical  poisoning,  the  gastro-intestinal 
mucous  membrane  exhibits  deep  redness,  erosions,  ecchymosis 
and  softening.  Death  generally  occurs  in  the  midst  of  con- 
vulsions, followed  by  rigid  spasm  of  the  whole  body. 

When  arsenic  has  been  injudiciously  administered  for  too 
long  a  period,  in  addition  to  the  irritation  of  the  conjunctiva, 
swelling  of  the  face,  desquamation  of  the  skin,  etc.,  salivation 
has  been  observed  in  some  instances,  and  at  times  a  peculiar 
silvery  whiteness  of  the  tongue. 

Dose. — Of  arsenious  acid,  gr.  -h  to  gr.  tV,  in  pills  with  bread 
crumb  three  times  a  day.  Of  liquor  potassii  arsenitis  (Fow- 
ler's Solution),  TTlij  to  TTLx,  three  times  a  day;  each  fluid 
drachm  contains  half  a  grain  of  arsenious  acid. 

Arsenic  is  contraindicated  in  infancy  and  childhood ;  in  all 
sthenic  diseases  accompanied  by  strong  arterial  action ;  in  all 
irritable  conditions  of  the  stomach  and  alimentary  canal ;  and 
in  all  inflammatory  and  pulmonary  affections. 

Thej'apeutic  Uses. — In  intermittent  and  perio'dic  diseases, 
such  as  malaria,  neuralgia  and  spasmodic  affections,  being  of 
great  value  in  neuralgia,  especially  when  of  a  malarial  type, 
hemicrania,  chronic  rheumatism,  asthma,  whooping-cough, 
chorea,  diseases  of  the  skin,  vomiting  of  pregnancy,  hay  fever, 
irritative  dyspepsia,  uterine  affections,  bites  of  venomous 
snakes,  etc.  Externally  it  is  applied  to  cancerous  growths ; 
hypodermically,  in  cases  of  local  chorea. 

Arsenic  is  also  employed  medicinally  in  the  forms  of  arseni- 
ate  of  iron  {Ferri  Arsenias)  and  arseniate  of  soda  {Sodce 
Arsenias). 


ARSENIOUS   ACID.  173 


Dental  Uses. — The  devitalizing  power  of  arsenious  acid 
being  far  more  powerful  than  its  escharotic  power,  it  has  been 
employed  for  many  years  to  destroy  the  vitality  of  the  pulps 
of  teeth,  for  which  purpose  it  is  generally  combined  with 
either  the  acetate  or  sulphate  of  morphia  and  sufficient  crea- 
sote  to  form  a  paste,  to  prevent,  or  at  least  mitigate,  the  ex- 
tremely painful  action  of  the  arsenic  when  topically  applied  to 
living  tissue.  It  was  formerly  supposed  that  creasote  was  a 
solvent  for  the  arsenic,  but  this  is  now  denied.  Carbolic  acid 
may  be  substituted  for  the  creasote. 

As  the  danger  of  absorption  is  great,  there  is  considerable 
risk  in  applying  arsenious  acid  to  the  teeth  of  young  persons, 
or  those  very  susceptible  to  the  influence  of  this  agent ;  hence 
other  escharotics,  such  as  repeated  applications  of  carbolic 
acid,  or  pepsina  porci,  with  dilute  hydrochloric  acid,  or  nitric 
acid,  chromic  acid,  or  chloride  of  zinc,  or  the  galvanic  cautery, 
or  the  surgical  method  of  introducing  into  the  body  of  the 
pulp  a  barbed  wire,  are  employed  in  such  cases.  The  arsenious 
acid,  when  employed  for  the  devitalization  of  dental  pulps, 
has  been  combined  with  pulverized  charcoal,  under  the  im- 
pression that  the  latter  prevents  the  rapid  absorption  of  the 
arsenic,  and  thus  limits  its  action  mechanically  rather  than 
therapeutically. 

The  creasote  (or  carbolic  acid),  employed  in  combination 
with  the  arsenious  acid  as  a  nerve  paste,  obtunds  sensibility, 
acting  as  a  styptic,  antiseptic  and  escharotic ;  hence  some 
depend  upon  this  agent  alone  to  modify  the  action  of  the 
arsenic,  and  dispense  with  the  morphine. 

Tannic  acid  and  tincture  of  aconite  are  sometimes  substi- 
tuted for  the  morphine  and  creasote,  or  carbolic  acid,  in  the 
preparation  of  a  nerve  paste.  Arsenious  acid  is  also  employed 
alone,  in  the  form  of  a  dry  powder,  to  devitalize  pulps  of  teeth  ; 
but  it  is  not  only  more  painful,  but  less  prompt  in  its  action 
than  when  it  is  combined  with  other  agents.  Previous  to  the 
application  of  the  arsenical  preparation,  chloroform,  tincture 
of  aconite,  sulphate  of  atropine,  cocaine,  etc.,  may  be  applied 
to  the  exposed  portion   of  the  pulp,  and  the  painful  effect  of 


174  DENTAL  MEDICINE. 


the  arsenic  be  thus  modified.     The  spray  of  rhigolene,  or  ab- 
solute ether,  has  also  been  employed  for  this  purpose. 

The  quantity  of  arsenious  acid  to  be  employed  for  devitali- 
zation will  depend  upon  the  structure  and  class  of  the  tooth, 
varying  from  the  t^^,  to,  A  to  the  A  of  a  grain  ;  also  the  length 
of  time  the  arsenical  preparation  should  remain  in  the  tooth,  as 
the  condition  of  the  pulp  and  tooth,  the  age  of  the  patient,  the 
quality  of  the  tooth  structure  and  the  susceptibility  of  the 
patient  should  all  be  considered.  While  in  most  cases  pulps 
are  readily  devitalized  by  the  application  of  a  moderate  quantity 
of  the  agent,  in  other  cases  it  appears  to  be  impossible  to 
accomplish  this  object  without  extra  measures  are  resorted  to. 
In  teeth  of  a  soft,  frail  structure,  owing  to  an  excess  of  organic 
matter,  the  arsenic  is  rapidly  absorbed;  but  if,  on  the  other 
hand,  the  tooth  is  of  a  dense  structure,  the  retention  of  the 
arsenical  preparation  for  a  much  longer  time  may  not  be 
attended  with  any  injurious  effects,  such  as  peridental  inflam- 
mation. From  twelve  to  twenty-four  hours  are  generally 
required  to  enable  the  arsenious  acid  to  properly  devitalize  the 
pulp  of  a  tooth ;  the  difference  in  time  depending  upon  the 
quantity  of  the  acid  employed,  as  well  as  upon  other  circum- 
stances already  enumerated.  To  produce  a  speedy  effect,  the 
pulp  should  be  freely  exposed  by  the  careful  application  of  the 
excavator,  and  the  devitalizing  agent  applied  directly  to  the 
exposed  surface  of  the  organ.  Accuracy  as  to  the  quantity  of 
the  arsenious  acid  to  be  employed  may  be  arrived  at  by  hav- 
ing a  grain  divided  into  forty  to  sixty  parts,  by  weight,  in  the 
form  of  the  dry  powder.  A  pellet  of  cotton,  on  the  end  of  an 
excavator,  may  then  be  saturated  with  creasote  or  carbolic 
acid  or,  what  may  be  more  painless,  oil  of  cloves,  and  the  de- 
sired quantity  of  the  powder,  being  taken  up  on  the  pellet,  can 
be  placed  directly  in  contact  with  the  exposed  surface  of  the 
pulp,  and  secured  in  the  carious  cavity  by  means  of  a  second 
pellet  of  cotton,  saturated  with  either  sandarach  or  shellac  var- 
nish, a  solution  of  gutta  percha  and  chloroform,  wax,  or  sof- 
tened gutta  percha.  To  properly  secure  the  arsenical  prepa- 
ration in  the  cavity  of  a  tooth,  a  concave  disk  of  thin  platinum 


ARSENIOUS   ACID.  175 


may  be  placed  over  it,  and  a  temporary  filling  of  soft  gutta 
percha  introduced  into  the  carious  cavity.  Many  condemn  the 
use  of  sandarach  or  other  varnish  to  seal  the  arsenic  into 
cavities,  preferring  a  filling,  such  as  softened  gutta  percha,  etc., 
to  confine  the  arsenic  more  securely. 

Dr.  Chas.  Truman  suggests  a  mixture  of  iodoform  and  ar- 
senious  acid  as  a  painless  devitalizer  under  all  conditions.  It 
is  applied  as  follows:  After  placing  the  rubber  dam  in  position, 
drying  cavity,  etc.,  the  amount  of  the  arsenious  acid  it  is  pro- 
posed to  employ  is  placed  upon  a  glass  slide  and  an  equal 
quantity  of  iodoform,  or  an  excess  is  added  and  a  paste  made 
with  a  five  per  cent,  solution  of  carbolic  acid,  and  the  whole 
carried  to  the  pulp  on  a  piece  of  cotton,  the  size  of  a  pin's 
head.  This  is  then  covered  with  a  gutta  percha  cap,  or  one 
of  platinum,  and  a  temporary  filling  introduced;  the  latter 
may  consist  of  softened  gutta  percha  or  zinc  filling  material. 
Pressure  upon  the  pulp  must  be  avoided. 

Some  prefer  to  wound  the  pulp,  so  as  to  draw  blood,  before 
the  application  of  the  arsenical  preparation  is  made,  and  thus 
insure  its  speedy  action.  Care  is  necessary  that  the  arsenic 
should  be  completely  secured  in  the  carious  cavity,  and  no 
portion  of  it  come  in  contact  with  the  parts  outside  of  the 
tooth.  In  the  case  of  proximal  cavities,,  a  roll  of  bibulous 
paper,  saturated  with  sandarach  varnish,  may  be  pressed  be- 
tween the  teeth,  beyond  the  cavity,  and  thus  prevent  the 
arsenical  preparation  from  coming  in  contact  with  the  gum 
and  cheek,  or  gutta  percha  may  be  softened  and  packed 
against  the  margin  of  the  gum  in  such  a  quantity  as  will  fill 
the  interspace.  Failure  to  observe  such  precautions  may  re- 
sult in  violent  inflammation  involving  the  alveoli  and  causing 
necrosis  of  the  bone.  After  the  devitalization  of  the  pulp  has 
been  accomplished,  it  is  necessary  that  every  particle  of  the 
arsenic  should  be  removed  from  the  tooth.  The  effect  of  per- 
mitting the  agent  to  remain  in  the  tooth  for  a  longer  time 
than  is  necessary  for  the  devitalization  of  the  pulp  only,  is 
peridental  inflammation.  Where  several  applications  of  the 
arsenical  preparation  fail  to  produce  the  desired  devitalization, 


176  DENTAL  MEDICINE. 


the  resistance  thus  offered  to  the  influence  of  the  agent  may 
be  owing  to  several  causes :  a  granulated,  protective  covering, 
which  is  formed  over  the  surface  of  the  exposed  portion  of  the 
pulp,  which  defends  it  from  the  action  of  the  arsenic ;  or, 
extraordinary  vital  power  in  the  pulp,  which  may  be  due  to 
the  peculiar  constitution  of  the  patient,  who  probably  would 
not  be  as  susceptible  to  the  action  of  arsenic  as  the  majority 
of  persons  are,  even  if  it  were  administered  by  the  mouth. 

Such  resistance  to  the  action  of  the  devitalizing  agent  may 
be  overcome  either  by  the  removal  of  the  granulated  surface 
where  it  exists,  or,  in  cases  of  non-susceptibility,  by  punctur- 
ing the  pulp  with  a  pointed  instrument,  charged  with  the 
arsenical  preparation ;  first  taking  the  precaution  to  obtund 
the  sensibility  of  the  organ  by  the  application  of  a  benumbing 
agent.  The  action  of  arsenic  depends  upon  both  local  and 
systemic  conditions.  When  the  capillaries  of  the  pulp  are 
congested  as  a  result  of  the  inflammation,  the  absorption  of 
the  agent  is  prevented  or  retarded,  and  it  acts  chemically  upon 
the  superficial  tissue  of  the  exposed  portion  of  the  pulp  and 
causes  pain,  rendering  it  necessary  to  relieve  the  congestion 
before  the  nerve  tissue  can  be  primarily  affected.  In  case  of 
a  lymphatic  temperament,  characterized  by  low  vital  power 
and  excess  of  fluids  in  the  tissues,  the  arsenic  is  readily  ab- 
sorbed and  devitalization  speedily  results ;  whereas  in  cases 
where  there  is  great  nerve-power  or  excessive  nervous  irrita- 
bility, the  susceptibility  of  the  tissues  to  its  influence  is  very 
feeble,  and  the  devitalization  of  the  pulp  is  difficult  and  some- 
times impossible,  unless  repeated  applications  are  made. 

It  is  not  considered  advisable  to  apply  arsenious  acid  to 
a  dental  pulp  in  an  acute  stage  of  inflammation,  and  the 
method  generally  pursued  in  such  cases  is  to  remove  the 
loose  matter  in  the  cavity,  first  applying  the  rubber  dam,  and 
relieve  the  congestion  by  slightly  puncturing  the  pulp  so  as  to 
cause  a  slight  hemorrhage.  Then  apply  an  anodyne,  such  as 
oil  of  cassia,  oil  of  cloves,  eugenol,  terpinol,  or  other  agent  of 
like  properties.  This  should  be  carefully  sealed  in  the  cavity, 
without  pressure  being  made  upon  the  pulp,  for  from  one  to 


ARSENIOUS   ACID.  I77 


three  days,  according  to  the  degree  of  inflammation  existing 
in  the  parts.  At  the  expiration  of  such  time,  the  dressing  is 
removed,  and  if  the  inflammation  has  subsided,  as  is  shown 
by  the  symptoms  presented  during  the  period  the  dressing 
has  remained  in  the  tooth,  an  appHcation  of  arsenious  acid 
may  be  made.  Upon  the  removal  of  the  arsenic,  an  appHca- 
tion of  tannin  and  glycerin  should  be  made  in  order  to  harden 
the  devitalized  pulp  and  render  its  removal  easy  in  the  form 
of  an  entire  mass;  then  apply  some  efficient  antiseptic  dress- 
ing to  pulp-canal,  first  washing  out  with  peroxide  of  hydrogen. 
The  use  of  dialyzed  iron  is  also  recommended,  after  the  re- 
moval of  the  arsenic,  as  it  is  not  always  certain  that  the  latter 
agent  has  been  carefully  applied.  The  dialyzed  iron  is  intro- 
duced into  the  cavity  on  a  piece  of  wood.  The  cavity  should 
be  kept  free  of  moisture  from  the  time  of  the  application  of 
the  arsenic  up  to  the  time  of  the  application  of  the  dialyzed 
iron. 

When  arsenious  acid  is  applied  to  the  surface  of  an  exposed 
pulp,  its  first  effect  is  stimulating,  followed  by  paralysis  of  the 
sensory  nerves,  a  degree  of  inflammation  being  excited  which 
depends  upon  the  quantity  of  arsenious  acid  employed.  After 
the  stimulating  effect  passes  off  the  arsenic  is  gradually  ab- 
sorbed and  the  pulp  slowly  dies.  Too  large  a  quantity  of  the 
arsenic  will  cause  violent  inflammatory  action,  increase  the  con- 
gestion and  prevent  the  pulp  from  absorbing  the  agent;  and 
experience  has  shown  that  recently  exposed  pulps  are  more 
readily  devitalized  by  arsenious  acid  than  those  which  have 
been  exposed  for  a  considerable  time.  It  is  therefore  advisable 
to  employ  minute  quantities  of  arsenic  as  a  devitalizing  agent, 
and  to  avoid  pressure  on  the  pulp  when  applying  it,  so  that 
the  pain  occasioned  by  its  action  may  be  limited  to  the  space 
of  one  hour  on  an  average.  The  danger  of  an  excess  of  arsenic 
passing  through  the  apical  foramen  of  the  root  to  the  peri- 
dental membrane  must  always  be  guarded  against  by  carefully 
regulating  the  quantity  of  the  agent ;  on  the  other  hand  all 
extraneous  matters  that  will  interfere  with  the  action  and 
application  of  the  arsenic  to  the  exposed  surface  of  the  pulp 
12 


178  DENTAL  MEDICINE. 


must  be  removed,  or  irritation  and  pain  and  not  devitalization 
will  result.  For  the  application  of  arsenious  acid  to  the  sur- 
face of  a  fractured  tooth,  where  it  is  difficult  to  retain  it,  the 
filling  may  be  ligatured  in  place,  after  being  covered  with  a 
thin  layer  of  gutta  percha.  Dr.  E.  C.  Kirk  uses  for  such  a 
purpose  surgeon's  rubber  plaster,  carrying  it  around  the  tooth. 

Arsenious  acid  is  also  employed  in  dental  practice  to  obtund 
the  undue  sensitiveness  of  dentine,  but  less  frequently  now 
than  in  past  years,  as  its  action  is  due  more  to  devitalizing 
energy  than  to  a  chemical  action,  such  as  a  true  escharotic 
produces.  As  it  is  capable  of  being  absorbed  through  a  con- 
siderable thickness  of  dentine,  the  result  of  which  would  be 
the  death  of  the  pulp,  arsenious  acid,  if  it  is  employed  for  ob- 
tunding  the  sensibility  of  the  dentine,  should  be  suffered  to 
remain  in  the  tooth  but  a  very  short  time — from  one  to  three 
hours — and  every  particle  of  it  carefully  removed.  As  there 
are  many  agents  which  prove  effective  for  such  a  purpose,  it  is 
much  better  to  refrain  from  the  use  of  arsenious  acid  as  an 
obtunder  of  hyper-sensitive  dentine. 

When  arsenious  acid  comes  in  contact  with  the  soft  tissues 
of  the  mouth,  the  result  of  careless  application,  its  irritating 
effects  become  apparent  in  from  twelve  to  twenty-four  hours, 
beginning  with  a  slight  soreness  and  some  congestion.  Small 
ulcers  then  appear  which  increase  in  depth  but  are  not  attended 
with  much  pain,  unless  the  agent  penetrates  to  the  periosteum. 
The  parts  involved  eventually  become  quite  dark  in  color,  and 
sloughing  occurs  to  some  extent.  Dr.  Faught  suggests  the 
following  treatment :  "  Wherever  practicable,  the  soft  tissues 
should  be  curetted.  Scarify  freely,  and  then  touch  the  wound 
with  muriated  tincture  of  iron  ;  then  cauterize  it  with  carbolic 
acid  or  iodine,  and,  if  need  be,  stimulate  further  in  a  few  days 
with  another  application  of  the  same." 


ARSENIOUS   ACID. 


179 


DENTAL 

For  Devitalizing  Pulps  of  Teeth. 
Flagg. 
R .     Acidi  arseniosi   .    .    .  gr.j 
Morphinse  acetatis.     .  gr.  ij 
Acidi  carbolici    .    .    .  gtt.iij.      M. 
Fiat  massa. 
SiGNA. — The    proper    quantity    to    re- 
main 12  to  24  hours. 

Pierce. 
R .     Acidi  arseniosi    .    .    .  gr.x 
Morphinse  sulphatis   .  gr.xx 

Creasoti q.s. 

To  make  a  thick  paste. 
SiGNA. — To  remain  24  hours  for  adults ; 
10  hours  for  children. 

Garrettson. 
R .     Acidi  arseniosi, 

Morphinte  acetatis  .    .  aa  gr.x 

Creasoti        q.s. 

To  make  a  thick  paste. 
SiGNA. — To  remain  24  hours  for  adults  ; 
10  hours  for  children. 
If  a  very  irritable  condition  is  pres- 
ent, sulphate  of  atropia  may  be  substi- 
tuted for  morphia. 

Hollander. 
R.      Acidi  arseniosi    .    .    .  gr.xij 
Morphinae  acetatis  .    ,  gr.ij 
Olei  caryophylli  •     .    .  gtt.iv 

Creasoti q.s. 

Ut  fiat  pasta. 

R.  Acidi  arseniosi  .  .  .  gr.v 
Acidi  tannici  ,  .  .  -gr.x 
Tincturse  aconiti  .  .  .  q.s. 
To  make  a  thick  paste. 

SiGNA. — To  remain  24  hours. 

J.   D.  White. 
R.     Acidi  arseniosi     .    .    .  gi-.ij 
Morphinae  sulphatis     .  gr.j 

Creasoti q.s.         M. 

Fiat  massa. 
Signa. — To  remain  from  I2  to  24  hours. 


FORMULA. 

R.    Acidi  arseniosi     .    .    .  gr.xx 
Morphinae  acetatis  .    .  gr.x 

Creasoti q.s. 

To  make  a  thick  paste. 
Signa. — To  remain  12  to  24  hours  for 
adults;  8  to  lO  hours  for  children. 

R.    Acidi  arseniosi    .    .    .gr.x 
Morphinffi  acetatis   .    .  gr.xl 
Creasoti,  vel  acidi  car- 
bolici      q.s. 

To  make  a  thick  paste. 
Signa. — To  remain  12  to  24  hours. 

E.  C.  Kirk. 

R .    Acidi  arseniosi    .    .    . 

Cocaini  hydrochloratis .  aa  gr.xx 
Menthol  cryst  .    .    .    .gr.v 

Glycerini enough    to 

make  a  stiff  paste.  M. 

Signa. — Use  the  desired  quantity,  and 
secure  it  with  a  lead  cap  covered 
with  gutta  percha. 

For  Malignant   Ulcerations  of  a  Can- 
cerous character. 

R  .    Liquoris  hydrargyxi  ni- 

tratis ^oJ* 

A  powerful  caustic. 

Signa. — Applied  by  means  of  a  camel- 
hair  brush,  and  the  parts  then  covered 
with  lint. 

R .    Acidi  arseniosi    .    .    .  i  part 
Cocaini  hydrochloras  .  4  parts 
Lanolin 5  parts.  M 

Signa. — To  remain  24  hours. 

For  Painless  Devitalization. 

R .    Acidi  arseniosi    .    .    .  gr.^'^j 

Olei  caryophilli    .    .    .  enough    to 
make  a  paste.  M. 

Or  a  pledget  of  cotton  may  be  satur- 
ated with  the  oil  of  cloves  and  tlie 
arsenioui  acid  taken  up  on  this  and 
applied  to  the  pulp. 


180 


DENTAL  MEDICINE. 


Devitalizing  Fibre. 

R.    Absorbent  cotton     .    .       (crosscut 
fine.) 

Arsenious  acid     .    .    .  gr.v 

Tannic  acid gr.  ij 

Acetate  of  morphine    .  gr.x 
Oily  carbolic  acid    .    .  q.s.    for     a 
thin  paste. 
Reduce  the  cotton  by  cutting  and  cross - 
cutting    to    a    soft    fine    fuzz,   then 
incorporate    it  with   the   above  mix- 
ture ;     dry   and    separate    into  small 
pieces  for  convenient  application. 
Or  arsenic,  morphine  and  cinnamon  ap- 
plied to  cotton  in    same    manner  as 
above. 

Devitalizing  Pulps  of  Teeth. 
Dr.  a.  W.  Harlan. 

First  apply  to  point  of  exposure 
vinum  opii  or  any  anodyne  (not  car- 
bolic acid)  for  a  minute  or  two,  then 
use  the  following : 

R.    Acidi  arseniosi     •    .    •    3J 
Hydrochlorate   of    co- 
caine    ......  gij 

Lanolin ad..q,s. 

To  make  a  stiff  paste. 


SiGNA. — Apply  a  small  quantity  to  the 
exposure  on  a  little  square  of  gummed 
paper  about  -^-^  of  an  inch  in  size ; 
this  should  be  covered  with  a  pellet 
of  cotton  saturated  with  liquid  vase- 
line and  the  cavity  filled  with  soft 
gutta  percha,  or  paste  of  oxyphos- 
phate  of  zinc.  This  application 
should  remain  48  hours  in  the  case 
of  an  adult;  24  hours  in  case  of  a 
patient  under  21  and  more  than  12 
years  of  age;  and  8  to  12  hours  in 
case  of  a  patient  under  1 2  years  of  age. 

For  Destroying  and  Removing  Pulps. 

Dr.  a.  W.  Harlan. 
R .    Acidi  arseniosi    .    .    .  gr.xc 
Cocaini  hydrochlor.     .  gr.x 

lodoformi gr.v  to  vij 

Either  oil  of  cloves;  or 
oil  of  cassia     .    .    .  q.s. 
To  form  a  stiff  paste. 
Apply  -gig  gr.  to  the  pulp  and  allow  it  to 
remain  48  hours.     Seal  cavity  with 
gutta  percha,  when   the  dressing  is 
removed  keep  cavity  dry,  and  wash 
it  with  dialyzed  iron,  and  apply  alco- 
holic solution  of  tannin.     Seal  cavity 
for  8  days,  when  the  pulp  may  be 
removed  painlessly.     The  root  may 
be  filled  at  once. 


Tests  for  Arsenic. — Arsenic,  in  the  solid  state,  may  be  de- 
tected by  its  volatility ;  heated  over  a  spirit-lamp,  it  passes  off 
in  the  form  of  a  white  vapor,  devoid  of  smell,  and  is  deposited 
on  a  cool  surface  as  an  amorphous  powder,  or  in  octahedral 
crystals.  When  arsenic  is  thrown  on  burning  charcoal,  it  is 
deoxidized,  and  gives  out  the  garlic  odor  of  metallic  arsenic. 
When  heated  in  a  glass  tube  with  charcoal  or  black  flux,  it 
sublimes,  and  condenses  in  the  form  of  a  brilliant  steel-gray 
ring  or  mirror. 

The  following  reagents  will  detect  it  when  it  is  in  aqueous 
solution  :  Sulphuretted  hydrogen,  or  sulphide  of  ammonium, 


BENZOIC   ACID.  181 


produces  a  lemon  or  yellow  sulphide  of  arsenic ;  the  addition 
first  of  ammonia,  and  then  of  nitrate  of  silver,  produces  a 
light-yellow  arsenite  of  silver  ;  the  addition  of  potassa,  and 
then  of  sulphate  of  copper,  produces  a  light-green  arsenite  of 
copper.  The  most  delicate  test,  however,  is  that  of  nascent 
hydrogen,  known  as  Marsh's  Test,  which  consists  of  subject- 
ing the  arsenic  to  the  action  'of  nascent  hydrogen  (evolved  by 
the  action  of  diluted  sulphuric  acid  on  pure  zinc) ;  it  is  de- 
oxidized, and  unites  with  the  hydrogen  to  form  arseniuretted 
hydrogen  gas,  which  has  the  odor  of  garlic,  and  burns  with  a 
bluish-white  flame,  depositing  a  black  spot  of  metallic  arsenic 
on  the  surface  of  a  cold  plate  held  directly  in  the  jet. 

Reinsch's  Test  consists  in  boiling  the  suspected  material 
with  hydrochloric  acid  and  clean  copper  foil,  when,  if  any 
arsenic  is  present,  the  copper  foil  becomes  coated  with  gray 
metallic  arsenic. 

Cobalt. —  Cobaltum  {Formula,  Co) — is  a  metal  chiefly  found 
in  combination  with  arsenic,  either  in  the  form  of  the  arsenide 
{tin-white  cobalt),  or  as  gray  cobalt  ore,  with  sulphur  and  ar- 
senic. The  late  Dr.  Robert  Arthur,  at  one  time,  preferred 
cobalt  as  a  devitalizing  agent  to  arsenious  acid,  being  of  the 
opinion  that  less  irritation  followed  its  action,  and  consequently 
greater  immunity  from  peridental  inflammation  ;  afterwards, 
however,  he  found  it  less  reliable  than  arsenious  acid.  At  the 
present  time  cobalt  is  not  considered  to  be  any  safer  than 
arsenic ;   it  is  also  less  prompt  in  its  action  as  a  devitalizing 

agent. 

ACIDUM   BENZOICUM— BENZOIC  ACID. 

Formula. — CyHgOg^^CgHg — CO,OH. 

Derivation. — Benzoic  Acid  is  obtained  from  benzoin  (a  bal- 
samic resin,  which  exudes  from  the  incised  stem  of  a  tree  of 
Sumatra,  Java,  Borneo  and  Siam),  either  by  sublimation  or  by 
the  action  of  alkalies ;  it  is  also  made  from  hippuric  acid.  It 
is  in  the  form  of  white,  feathery  crystals,  of  a  silky  lustre,  a 
peculiar,  agreeable  odor,  and  warm,  acidulous  taste.  While  it 
is  sparingly  soluble  in  cold  water,  it  is  more  soluble  in  warm 
or  boiling  water,  and  very  soluble  in  alcohol,  solutions  of  po- 


182  DENTAL  MEDICINE. 


tassa,  soda,  ammonia,  lime  and  concentrated  sulphuric  and 
nitric  acids.  The  fixed  oils  also  dissolve  it.  From  solu- 
tion it  crystallizes  in  transparent  prisms.  It  is  also  inflam- 
mable. 

Medical  Properties  and  Action. — Benzoic  acid  is  stimulant, 
particularly  of  mucous  surfaces,  and  its  vapor  causes  great 
irritation  of  the  air  passages.  It  is  also  antiseptic  and  expec- 
torant, and  some  claim  that  it  is  a  more  powerful  antiseptic 
than  carbolic  acid.  Like  sa,licylic  and  boracic  acids,  it  pre- 
vents fermentation  and  putrefaction  and  destroys  minute  or- 
ganisms. In  the  system,  it  is  converted  into  hippuric  acid,  by 
the  assumption  of  the  elements  of  glycocol,  and  in  this  form 
is  excreted  in  the  urine ;  a  large  part  is  excreted  by  the  kid- 
neys, as  benzoic  acid. 

Therapeutic  Uses. — Benzoic  acid  is  employed  in  chronic 
cystitis,  gout,  calculous  diseases,  jaundice,  incontinence  of 
urine  in  children,  etc. 

Dose. — gr.  x. 

Dental  Uses. — Benzoic  acid  may  be  employed  as  an  anti- 
septic in  suppurating  and  gangrenous  conditions  of  the  pulps 
of  teeth  and  mucous  membrane;  also  as  a  local  haemostatic 
in  combination  with  powdered  alum.  It  forms  one  of  the  in- 
gredients of  Dr.  Chapin  A.  Harris'  Gum  Wash. 

The  tinctures  of  benzoin  are  employed  in  the  treatment  of 
unhealthy  and  sloughing  wounds,  flabby  granulations,  foul 
ulcers,  as  they  destroy  the  fetor  and  stimulate  to  a  more 
healthy  growth.  In  the  antiseptic  employment  of  benzoic 
acid,  it  may  be  used  as  a  substitute  for  boracic  and  salicylic 
acids.  The  addition  of  borax  will  increase  its  solubility  in , 
water. 

Benzoate  of  Ammonium — Ammortii  Benzoas — will  dissolve 
phosphatic  calculi,  if  its  use  is  long  continued. 

Benzoated  Lard,  when  employed  in  the  preparation  of  oint- 
ments, prevents  chemical  change,  such  as  rancidity  or  acridity. 
It  is  prepared  by  digesting,  at  a  moderate  heat,  5ij  of  pow- 
dered benzoin  with  a  pound  of  lard. 


BENZOIC   ACID.  183 


Antiseptic  Mouth   Wash. 
Dr.  W.  D.  Miller. 

R .         Acid  benzoic 3. 

Tinct.  eucalypti 15. 

Alcohol        100 

01.  Menth.  pip 0.75 

For  an  Antiseptic  and  Disinfectant  Mouth    IVash. 

Dr.  L.  p.  Bethel. 

R.        Benzoic  acid 
Orris  root 

Cinnamon,  pv.,  aa X*-*^ 

Soap  bark 2-oz 

Tannic  acid idr 

Borax gr.20 

01.  wintergreen SoTTt 

01.  peppermint idr 

Cochineal ^dr 

Sugar 4— oz 

Alcohol 12-oz 

Water 20-oz.  M. 

Macerate  6  days  and  filter. 

SlGNA.^ — For  rinsing  purposes  6  or  8  drops  in  half  a  glass  pf  water.     In 
stronger  solution  for  infiammation  and  pain  after  extraction. 

LiSTERiNE,  the  formula  of  which  is  thyme,  eucalyptus,  bap- 
tisia,  gaultheria,  and  mentha  arvensis,  in  combination,  each 
fluid  drachm  also  containing  two  grains  of  benzo-boracic  acid, 
is  largely  employed  as  an  antiseptic,  deodorizer,  and  disin- 
fectant, in  surgical  practice,  in  the  form  of  a  lotion,  a  gargle, 
a  dressing,  or  an  injection.  In  dental  practice,  listerine  is 
reliable  in  carious  teeth,  ulcerations  of  mucous  membrane,  and 
wounds  of  the  mouth,  in  the  form  of  a  lotion  or  dressing;  for 
alveolar  abscesses,  necrosis  and  caries  of  maxillary  bones,  in 
the  form  of  injections  and  lotions;  after  the  extraction  of  teeth, 
as  a  mouth  wash ;  and  for  offensive  breath,  as  a  gargle.  It 
may  be  employed  in  its  full  strength,  or  in  various  degrees  of 
dilution  with  water. 

For  such  diseases  as  diphtheria,  catarrh,  dysentery,  scarla- 
tina, erysipelas,  smallpox,  different  forms  of  fevers,  etc.,  the 
dose  is  one  teaspoonful  three  or  more  times  a  day  (as  indi- 
cated). 


184  DENTAL  MEDICINE. 


For  Stomatitis  of  Dentition. 

R.    Listerine gj 

R.    Listerine ^j  Glycerine §ss 

Syr.  simplicis   ....  ^vij.      M.  Water  .    .    .    .  qs.  ad.   ^ij.        M. 

SiGNA.  — A   teaspoonful   every    2   to  4 
hours  after  nursing  or  feeding. 
or — 

For  Sore  Mouth  of  Nursing   Women. 

R .        Listerine 

Glycerine aa  ^vj 

Rose  water ^ijss.         M. 

SiGNA. — Use  as  a  mouth-wash. 

Local  AncBsthetic . 
Dr.  L.  p.  Bethel. 

R .        Listerine ^  ij 

Carbolic  acid  (crystals) grs.x 

Gum  camphor grs.viij 

Iodoform ^ss 

Pond's  ext.  hammamelis ^ij.  M. 

SiGNA. — Used  hypodermically. 

ACIDUM   BORICUM— BORIC   ACID— BORACIC   ACID. 

Formula. — 2  H3BO3. 

Derivation. — Boric  Acid,  formerly  called  Boracic  Acid,  is 
obtained  artificially  by  decomposing  a  hot  saturated  solution 
of  borax  with  sulphuric  acid,  which  unites  with  the  soda  to 
form  sulphate  of  soda,  and  liberates  the  acid.  It  is  in  the  form 
of  white,  shining  crystals,  of  a  scaly  nature.  It  is  soluble  in 
26  parts  of  cold  water,  in  three  parts  of  warm  water,  and  feebly 
soluble  in  alcohol. 

Medical  Properties  and  Action. — Boric  acid  is  antiseptic  and 
deodorant.  It  destroys  minute  organisms,  and  arrests  fer- 
mentation and  putrefactive  decomposition,  and  is  said  to  be  as 
effective  an  antiseptic  as  carbolic  acid,  and  less  irritating  than 
salicylic  acid. 

Therapeutic  Uses. — It  is  locally  employed  as  a  dressing  for 
wounds,  ulcers,  burns,  scalds,  skin-grafting,  etc.,  as  it  is  non- 
irritating,  and  lessens  suppuration,  and  prevents  decomposi- 
tion.    Boric  acid  is  employed  in  all  the  forms  and  combina- 


BORACIC   ACID.  185 


tions  in  which  carbolic  and  salicylic  acids  are  used  by  the  anti- 
septic method,  in  the  form  of  a  saturated  solution. 

Boric  Lint  is  made  by  steeping  lint  in  a  saturated  solution 
of  boric  acid  at  the  boiling  point. 

Dose. — Of  boric  acid,  gr.  viij  to  xvj.  It  does  not  cause 
any  disturbance  of  the  stomach,  and  is  eliminated  in  the 
urine. 

Boro-glyceride  is  composed  of  boric  acid  62  parts,  and 
glycerine  92  parts,  each  gently  heated  over  a  water  bath  and 
the  boric  acid  gradually  added  to  the  glycerine,  and  the  heat 
continued  until  54  parts,  or  three  molecules  of  water  are  driven 
off.  It  is  amber-colored  and  very  friable,  and  proves  to  be  a 
valuable  antiseptic. 

Boro-glyceride  has  an  acid,  pungent  taste,  and  an  astringent 
effect  on  mucous  membranes,  and  is  free  from  some  of  the 
objections  to  the  use  of  the  boric  acid  powders.  (See  Gl5^cerine 
for  Glyceroborates  of  Sodium  and  Calcium). 

Boric  Ointment  is  composed  of  boric  acid,  i  part;  paraffin, 
2  parts  ;  almond  oil,  2  parts.  When  used  it  should  be  mixed 
with  a  little  glycerine. 

Mel  Sodii  Boratis — Honey  of  Borax — is  composed  of  borax, 
60  grains  ;  honey,  i  troy  ounce. 

Dental  Uses. — Boric  acid  may  be  employed  as  an  antiseptic 
in  all  the  forms  and  combinations  in  which  carbolic  and 
salicylic  acids  are  u.sed,  and  when  it  is  combined  with  sulphite 
of  soda  the  compound  forms  a  valuable  preparation  for  bleach- 
ing discolored  teeth.     (See  Sulphite  of  Soda.) 

Boric  acid,  in  10  per  cent,  solution,  may  be  used  with 
benefit  in  the  form  of  an  injection  into  suppurating  cavities. 
As  a  mouth-wash  and  gargle  it  is  employed  in  a  solution  com- 
posed of  twenty  grains  to  the  ounce  of  water.  Combined 
with  glycerine  in  the  form  of  boro-glyceride,  a  valuable 
application  is  secured  for  antiseptic  dressings  and  injections. 
One  part  of  boric  acid  in  130  of  water  is  used  as  a  germi- 
cide. 


186 


DENTAL  MEDICINE. 


For  Alveolar  Pyorrhoea. 


R 


Creta  preparatce    .    .    •    ,^j 

Acidumboricum  .    .    .   gj.  M. 

SiGNA. — Apply  this    powder  to    gums 

about  necks  of  teeth,  after  all  deposits 

have  been  thoroughly  removed,  and 

aromatic  sulphuric  acid  injected. 


For  Chapped  Lips  and  Abrasions. 

li  .    Acidum  boricum  ...     2  parts 

Vaselin 30  parts 

Glycerini 3  parts 

Attar   of    Roses,  for   perfume,    a    fevv^ 
drops,  if  used  as  a  lip  salve. 

Antiseptic  Mouth    Wash. 

R .    Boric  acid ^  ss 

Carbolic  acid    ....  gr.xv 

Thymol gr.iv 

Water Oj.  M. 


Mouth    Wash. 

R.  Boro-glycerine  •  •  •  ^j 
Carbolic  acid  •  •  -  •  3J 
Water ^^^^j- 


For  Aphthous  Ulcerations  of  Mouth,  Fis- 
sured Tongue,  Abrasions  by  Arti- 
ficial Dentures,  etc. 
C.  N.   Peirce. 
R.    Acidum   boricum    .    .  grs.lxiv 
01  ei  gaultherias    .    .      fgss 

Glycerini f^iv 

Alcoholis f§j 

Aquas  enough  to  make  4  ounces.        M  • 

Temporary    Capping  for   Exposed 
Pulps. 

Dr.  H.  Milling. 
R ,    Boric  acid 

White  vs^ax aa  i  part 

Oil  of  sweet  almonds 

Parafhn aa  2  parts 


Antiseptic  Solution. 

Thiersh. 

H: .    Acidi  borici     .    .    . 

.  grs.76 

Acidi  salicyli    .    .    . 

.  grs.xvj 

Aquse  ferventis     .    . 

.Oj. 

Antiseptic  Mouth 

Wash. 

R .    Boric  acid    .... 

■  3vij 

Phenic  acid  .    .     ■    . 

.  grs.xv 

Thymol 

.  grs.viij 

Essence  peppermint 

.  gtt.xx 

Tinct.  anise      .    .    . 

•  31JSS 

Water 

-Oij. 

M. 


M. 


For  Capping  Exposed  Pulps. 

R .        Acidi  borici 

White  wax aa  i  part 

Oil  sweet  almonds 

Paraffin aa  2  parts.     M. 


ACIDUM   CARBOLICUM— CARBOLIC   ACID. 
PHENIC  ACID;   PHENYLIC  ALCOHOL;   PHENOL. 

Formula. — CgHgO  H . 

Derivation. — Carbolic  Acid  is  obtained  from  coal  tar  by  frac- 
tional distillation  and  subsequent  purification,  being  extracted 


CARBOLIC   ACID.  187 


from  that  part  of  the  heavy  coal-tar  oils  which  distill  over 
between  150°  and  200°  Centigrade.     Specific  gravity  1.065. 

When  pure,  it  is  in  the  form  of  colorless  acicular,  interlac- 
ing crystals,  which  at  95°  F.  become  an  oily  liquid,  possessing 
a  strong  odor  and  taste,  closely  resembling  creasote,  having 
similar  characters  and  properties,  although  it  is  a  different 
substance.  Much  of  what  is  called  creasote  is  nothing  but 
impure  carbolic  acid  {Aciduni  Carbolicum  hnpuriuii),  com- 
bined with  two  other  substances,  similar  in  constitution,  and 
known  as  creasole  and  phosole. 

Chemically  considered,  carbolic  acid  is  an  alcohol  rather 
than  an  acid,  and  its  crystals  readily  absorb  moisture  on  ex- 
posure to  the  air,  and  are  thus  liquefied. 

It  crystallizes  at  70°  F.,  and  becomes  Hquid  at  from  90°  to 
95°  F.,  and  fuses  at  93°  to  106°.  It  is  freely  soluble  in  alcohol, 
ether,  chloroform,  glycerine  and  the  essential  oils.  When 
carbolic  acid  is  liquefied  and  discolored  by  exposure,  it  is  dififi- 
cult  to  detect  it  from  creasote,  as  it  possesses  the  same  odor, 
taste,  caustic  properties,  and  a  like  affinity  for  albumen.  Car- 
bolic acid  is  soluble  in  from  twenty  to  twenty-three  parts  of 
water,  the  purest  being  the  most  soluble.  A  small  quantity 
of  water  will  convert  it  into  the  liquid  state,  but  will  not  dis- 
solve it.  Water  dissolves  six  per  cent,  of  carbolic  acid,  and 
five  parts  dissolve  in  one  part  of  alcohol ;  four  in  one  part  of 
ether;  three  in  one  part  of  chloroform;  seven  in  two  parts  ot 
glycerine,  and  four  in  seven  parts  of  olive  oil.  It  is  also  solu- 
ble in  carbon  disulphide,  benzol  and  fixed  and  volatile  oils. 
The  best  quality  of  carbolic  acid  contains  two  per  cent,  of 
water,  and  should  be  hard  and  dry,  with  no  odor  of  creasote 
nor  of  volatile  sulphur  compounds.  Crystallized  carbolic  acid 
may  be  dissolved  by  a  small  quantity  of  cologne  water ;  and 
to  prevent  recrystallization  and  prepare  it  for  use  (in  the  form 
of  injections,  for  example),  the  bottle  containing  it  should  be 
warmed  by  immersion  in  hot  water,  until  it  becomes  fluid,  and 
about  five  per  cent,  of  rectified  alcohol,  or  a  few  drops  of 
glycerine,  be  added. 

The  red  color  which  it  assumes  on  exposure  is  thought  to 


188  DENTAL  MEDICINE. 


be  caused  by  the  ammonia  in  the  air,  and  also  by  the  presence 
of  copper  in  the  acid,  which  is  affected  by  the  ammonia  of  the 
atmosphere. 

Medicinal  Properties  and  Action. — CarboHc  acid  resembles 
creasote  so  closely  in  many  of  its  characters  and  medicinal 
properties,  that  the  therapeutic  applications  are  the  same  in 
the  case  of  both  of  these  substances.  Many,  however,  con- 
sider carbolic  acid  to  be  more  efficacious  in  obstinate  dis- 
charges than  creasote  ;  and  also  less  irritating  in  its  crystalline 
form  when  applied  to  very  sensitive  organs,  such  as  the  pulp 
of  a  tooth. 

In  its  pure  state  -it  is  escharotic;  when  diluted,  it  is  rube- 
facient, anaesthetic  and  antiseptic.  Internally  administered,  it 
is  sedative  and  carminative,  possessing  the  power  of  allaying 
vomiting  and  gastric  irritability. 

Its  powers  as  an  antiseptic  and  germicide  are  not  now  con- 
sidered to  be  equal  to  those  of  some  other  substances,  such  as 
bichloride  of  mercury,  iodine,  iodoform,  etc.,  although  it  is  yet 
regarded  as  a  useful  and  important  agent.  It  is  irritant  to  the 
skin  and  other  tissues,  and  capable  of  being  absorbed  to  a 
dangerous  amount.  Eisentein  regards  carbolic  acid  as  an  anti- 
pyretic as  inferior  to  salicylic  acid,  and  others  regard  boric 
acid  as  possessing  equal  antiseptic  properties.  As  a  local 
anaesthetic,  carbolic  acid  exerts  a  very  soothing  influence  upon 
painful  tissues ;  hence  it  is  beneficial  in  odontalgia,  and  for 
pulp  dressing.  On  account  of  its  solubility,  a  variety  of  solu- 
tions of  special  value  can  be  formed  with  it,  which  are 
especially  serviceable  as  antiseptic  applications. 

The  application  of  large  quantities  of  carbolic  acid  to  an 
extensive  surface  is,  however,  dangerous,  as  cases  of  fatal 
poisoning  have  resulted  by  the  absorption  of  this  acid;  hence, 
care  is  necessary  in  its  use  as  an  external  application. 

Its  nauseous  odor  and  taste  and  its  caustic  action  render  it 
objectionable,  unless  greatly  diluted,  for  internal  administra- 
tion. To  obviate  such  objections,  it  is  recommended  to  use  it 
in  the  form  of  sulpho-carbolates. 

When  applied  to  the  skin  or  to  mucous  membrane,  it  pro- 


CARBOLIC   ACID.  189 


duces  a  burning  sensation,  of  short  duration,  and  the  eschar 
is  at  first  whitish,  afterward  becoming  brown  or  black,  and 
surrounded  by  a  zone  of  inflammatory  redness ;  and,  notwith- 
standing its  power  to  coagulate  albumen,  is  rapidly  diffused 
into  the  blood.  Carbolic  acid  exists  in  the  blood  as  a  carbo- 
late;  and  the  blood  itself  does  not  appear  to  undergo  any 
change  in  its  corpuscular  elements.  It  is  in  part  consumed  in 
the  body,  and  the  products  of  its  combustion  are  excreted 
in  the  urine.  Solutions  of  carbolic  acid  of  adequate  strength 
will  check  suppuration,  and  correct  the  fetor  of  ulcers,  etc. 

Therapeutic  Uses. — Internally,  it  is  employed  for  nausea  and 
vomiting  due  to  an  irritable  state  of  the  stomach,  in  scarlatina, 
measles  and  smallpox,  pyrosis,  etc.;  as  a  gargle  in  diphtheria; 
as  an  inhalation  in  chronic  nasal  catarrh,  hay  asthma,  whoop- 
ing-cough, phthisis,  etc. ;  as  an  injection  in  chronic  cystitis, 
primary  syphilis,  erysipelas,  pleuro-pneumonia  and  uterine 
diseases ;  as  a  lotion  in  gangrenous  and  other  ill-conditioned 
ulcers,  carbuncle,  poisoned  wounds,  burns,  skin  diseases, 
scrofulous  ophthalmia  and  itching  of  the  skin. 

Dose. — Of  crystallized  carbolic  acid,  gr.  %  to  gr.  j,  largely 
diluted.  A  better  form,  however,  is  one  drop  of  the  crystallized 
acid,  liquefied  by  heat,  in  one  ounce  of  mucilage,  three  times 
a  day.  The  dose  of  glycerite  of  carbolic  acid  {Glyceritum 
Acidi  Carbolici),  made  by  rubbing  together  oij  of  carbolic  acid 
with  Oss  of  glycerine,  is  1Uiv. 

The  dose  of  carbolic  acid  water  {Aqua  Acidi  Carbolici),  f5x; 
of  the  glycerite,  dissolved  in  distilled  water,  enough  to  make 
the  mixture  measure  a  pint,  the  dose  is  f5ss  to  f5j- 

Impure  carbolic  acid  is  employed  for  disinfectant  purposes. 

Ointment  of  carbolic  acid  {Unguentum  Acidi  Carbolici) — 
carbolic  acid,  5j ;  lard,  Sj. 

Sulphuphenol. — Sulpho-carbolic  acid,  CgH^  (O^)  (S020H)=r 
Cg  Hg  SO4,  is  produced  by  the  action  of  sulphuric  acid  on 
phenol,  and  is  considered  to  be  a  very  efificient  antiseptic  and 
disinfectant.  The  addition  of  acids,  particularly  sulphuric,  to 
crude  carbolic  acid  of  different  strengths,  increases  its  anti- 
septic and  disinfectant  properties,  and  considerably  increases 


190  DENTAL   MEDICINE. 


its  solubility.  Twenty-five  per  cent,  of  crude  carbolic  acid, 
mixed  with  an  equal  quantity  of  concentrated  crude  sulphuric 
acid,  gives  the  best  results,  and  renders  it  a  cheap  and  effec- 
tive disinfectant  and  sterilizer. 

Aseptol,  crude  sulphophenol  (sulpho-carbo  orthoxyphenyl- 
sulphurous  acid),  is  a  syrupy  rose-colored  volatile  liquid  with 
a  strong  odor,  and  a  non-irritant  action.  It  readily  dissolves 
in  every  proportion  of  water,  alcohol  and  glycerine.  Although 
it  is  more  acid  than  carbolic  acid,  yet  it  is  less  caustic,  and 
directly  combines  with  bases.  It  is  non-toxic,  antifermenting, 
antiputrid,  and  its  disinfecting  properties  are  more  energetic 
than  those  of  carbolic  and  salicylic  acids.  It  can  readily  be 
combined  with  the  essential  oils.  It  is  recommended  as  a 
substitute  for  carbolic  acid. 

Sulpho-carbolate  of  zinc  (Zn(CgH5S04)2H20)  combines  the 
virtues  of  zinc  salts  and  carbolic  acid,  and  is  used  internally, 
in  diarrhcea,  and  externally,  in  aqueous  solution  of  from  three 
to  six  grains  to  the  ounce,  as  a  dressing  for  wounds  and  ulcers 
and  an  injection  in  gonorrhoea. 

Sulpho-carbolates  of  sodium,  potassium,  magnesium,  cal- 
cium and  quinia  are  employed  as  antiseptics  in  cholera  and 
zymotic  diseases  generally. 

Dental  Uses. — Carbolic  acid  being  antiseptic,  styptic,  eschar- 
otic,  stimulant  and  sedative,  or  narcotic,  is  a  valuable  agent  in 
dental  therapeutics.  It  has  been  employed  as  an  application 
to  carious  dentine,  to  obtund  sensibility  and  arrest  putrefactive 
changes  in  the  devitalized  structure,  and  to  coagulate  the 
albuminous  elements  at  the  end  of  the  dentinal  tubuli. 

But  it  is  now  generally  conceded  that  there  are  other  agents 
which  are  more  permanent  in  their  action  as  antiseptics,  and 
hence  carbolic  acid,  it  is  claimed,  should  not  be  introduced 
into  root-canals  permanently,  as  silico-fluoride  of  sodium, 
boro-glycerine,  oil  of  cloves,  cassia,  cinnamon,  myrtol,  etc., 
are  far  more  powerful,  with  better  stimulating,  antiseptic  and 
disinfectant  properties,  and  do  not  possess  the  coagulating  pro- 
perty of  carbolic  acid,  nor  clog  a  delicate  canal  or  destroy  the  tis- 
sues to  which  they  are  applied.  Carbolic  acid  relieves  odontalgia 


CARBOLIC   ACID.  191 


when  applied  to  the  surface  of  an  exposed  and  painful  pulp.  It 
is  also  invaluable  in  the  treatment  of  alveolar  abscess ;  and  in 
combination  with  iodine  or  other  agents  it  is  often  employed 
with  beneficial  effects  in  the  treatment  of  periodontitis.  When 
employed  in  the  treatment  of  alveolar  abscess,  as  an  antiseptic, 
although  the  discharge  of  pus  may  be  increased  for  a  short 
time  after  its  application,  there  is  soon  manifested  a  decided 
diminution  in  the  quantity  secreted.  When  applied  to  a  sup- 
purating pulp  it  arrests  putrefaction,  and  induces  a  healthy 
action  without  irritation.  It  is  also  a  valuable  antiseptic  appli- 
cation in  ulcerations  of  the  mucous  membrane  of  the  mouth, 
gangrenous  conditions  and  mercurial  stomatitis;  for  such 
purposes  it  is  combined  with  glycerine  and  other  agents. 
Applied  to  exposed  pulps,  it  forms,  by  escharotic  action,  an 
eschar,  which  some  regard  as  conducive  to  the  recovery  of 
the  organ,  while  others  regard  the  quiescent  state  it  produces 
as  an  indication  of  the  degeneration  of  the  pulp,  and  hence 
prefer  to  use  it  in  a  diluted  form,  for  the  same  object,  objecting 
to  its  employment  in  its  pure  state,  on  account  of  its  escharotic 
or  caustic  action. 

It  is  also  useful  as  a  styptic  in  case  of  superficial  hemor- 
rhage from  the  gums  after  the  extraction  of  teeth,  especially 
in  combination  with  other  agents.  A  preparation  known  as 
phenol  sodique  is  often  employed  for  such  a  purpose. 

Oil  of  cloves,  when  added  to  an  equal  quantity  of  carbolic 
acid,  will  disguise,  to  some  extent,  its  taste  and  odor.  It  can 
also  be  perfumed  by  adding  to  i  part  of  carbolip  acid  3  parts 
of  oil  of  lemon  and  100  parts  of  alcohol  (36  degrees).  Car- 
bolic acid  is  also  employed  to  check  the  hemorrhage  resulting 
from  the  application  of  leeches  to  the  mucous  membrane  ot 
the  mouth.  When  applied  to  an  ulcerated  surface,  it  should 
be  repeated,  as  pus  is  formed  or  fungous  growths  appear;  and 
having  formed  an  eschar  when  applied  to  an  exposed  pulp,  it 
should  not  be  repeated  until  the  eschar  is  detached  from  the 
surface.  It  has  also  been  employed  in  the  form  of  hypo- 
dermic injections,  for  the  relief  of  neuralgia. 

Carbolic  acid  is   also   useful  as  a  local  anaesthetic.     Com- 


192  DENTAL  MEDICINE. 


bined  with  glycerine  (i  part  to  12  of  glycerine),  it  will  stimu- 
late the  mucous  secretion,  and  hence  has  been  applied  to  the 
palate  in  cases  of  deficiency  of  this  secretion  to  promote  the 
suction  of  upper  dentures. 

When  properly  diluted  with  alcohol,  it  renders  soft  and 
spongy  gums  firmer  and  less  tender. 

It  will  also  correct  fetor  of  the  breath  arising  from  carious 
teeth,  smoking,  etc.,  acting  as  a  deodorizer. 

In  all  fetid  discharges  from  the  mouth,  throat,  etc.,  carbolic 
acid,  combined  with  glycerine  or  an  aqueous  solution,  may  be 
used  with  advantage.  The  pure  acid  is  employed  for  bathing 
cavities  in  teeth,  preparatory  to  the  introduction  of  the  filling 
material,  for  its  effect  on  sensitive  or  softened  dentine  and  low 
organisms,  although  other  agents  prove  more  effective  as  ger- 
micides. 

For  use  as  a  disinfectant,  the  form  of  carbolic  acid  which 
contains  about  ninety-four  per  cent,  of  the  pure  acid  and 
known  as  "  carbolic  acid  No.  4/'  is  the  best,  and  it  may  be 
used  as  an  antiseptic  in  the  following  strength  :  for  lotions  or 
sponges,  2^  per  cent,  in  water;  for  spray  or  vapor,  5  per 
cent,  in  water ;  for  a  dressing,  5  per  cent,  in  olive  oil.  Car- 
bolate  of  potash  (unofficial — Robinson's  remedy)  is  composed 
of  equal  parts  of  carbolic  acid  and  caustic  potassa  rubbed 
together ;  it  is  employed  in  pyorrhoea  alveolaris  and  hyper- 
sensitive dentine.  Carbolic  acid  one-third  and  potassa  fusa  two- 
thirds  is  escharotic,  anaesthetic,  obtundant  and  disinfectant ; 
such  a  combination  causes  a  definite  slough,  and  is  useful  in 
suppurating  surfaces,  sloughing  ulcers  and  dead  tissue. 

Synthetic  Carbolic  Acid. — Hitherto  all  carbolic  acid  used  in 
medicine  has  been  prepared  from  coal-tar.  But  such  an  acid 
is  never  quite  pure,  always  containing  impurities  derived  from 
the  coal-tar.  Synthetic  carbolic  acid  is  produced  during  the 
process  of  sulphonizing  benzol  and  subsequent  fusion  of  the 
benzol-sulphonate  with  caustic  alkali.  The  most  characteristic 
difference  between  it  and  the  acid  prepared  from  coal-tar  is  the 
odor,  the  synthetic  acid  having  a  faint  "  pure  "  odor  not  like 
that  of  coal-tar,  and  almost  unperceivable  in  a  5  per  cent. 


CARBOLIC   ACID.  I93 


aqueous  solution,  differing  in  this  respect  also  from  the  com- 
mercial article.  Synthetic  carbolic  acid  is  in  two  forms — in  a 
coherent  crystalline  mass,  and  in  loose  crystals.  Experiments 
made  by  Dr.  Ohlmueller,  of  the  German  Health  Department, 
showed  that  the  synthetic  acid  diminished  the  life  activity  of 
the  bacteria  experimented  on  rather  less  than  the  older  acid, 
but  that  the  difference  was  so  small  that  the  two  kinds  might 
be  considered  to  be  practically  of  the  same  value.  One  of  the 
advantages  claimed  for  synthetic  carbolic  acid  is  its  greater 
solubility  in  water,  thus  enabling  the  operator  to  use  it  in 
greater  strength  without  diminishing  its  causticity. 

Phenol  Sodique  (unofficial)  is  a  solution  of  sodium  carbo- 
late,  and  is  extensively  employed  in  dental  practice  (See  Phe- 
nate  of  Soda).  It  is  composed  of  pure  melted  carbolic  acid, 
5  parts;  solution  of  caustic  soda  (of  a  specific  gravity  of  1.332), 
I  part ;  distilled  water,  5  parts.     Mix. 

Carbolate  of  Camphor  is  composed  of  carbolic  acid,  by 
weight,  one  part,  and  camphor,  by  weight,  three  parts. 

DENTAL   FORMULAE. 
A  Lotion  fo7-  Soft  and  Spongy   Gums.       For   Sensitive   Dentine   and  Alveolar 
R.    Acidi  carbolici     .    .    .  gr.xx  Pyorrhoea. 

Spiriti  rectificati  (alco-  D^^  j_  a.  Robinson. 

hoi)   ...     •    .    .    .   gij 
Aqua;  destillate  .    .    .^vj.      M.       ^-    Acidi  carbolici    .    .    .  (cryst.) 

It  renders  the  gum  less  tender  and  .^°^^"'^  ^^"^^^^  •  ~^  P^''^^^  ^^^^1- 

^j.jjjgj.  Misce,  by  triturating  in  a  mortar  until 

a  crystalline  paste  is  formed. 

An  Afitiseptic  Lotion  or  Injection.  SiGNA.— Apply  on  a  loosely  rolled  twist 

R.    Acidi  carbolici    .    .    .  ^^ss  of  cotton    about   neck  of  tooth,  for 

Glycerini ^xv.      M.  alveolar  pyorrhoea.     It  is  known  as 

For    alveolar    abscess    and  ulcers  of  \he  ^'  Robinson  Remedy.''^ 

mouth.      The    glycerine    modifies    the 

caustic  action  of  the  acid. 

A  Stimulant  and  Atttiseptic  Lotion. 
Dr.  J.  Stocken. 

R.    Acidi  carbolici     .    .    .   5J 

Glycerini ^iv 

Aquee ^x.       M. 

Useful  in  ulceration  of  the  gums  and 
mucous  membrane. 
13 


For   Alveolar  Pyorrhiea 

{Riggs'   Dis- 

ease). 

R.     Acidi   carbolici     .    . 

■  m>^xv 

Potassii  iodidi  .    .    . 

•  gr.v 

Zinci  chloridi    .    .    . 

.  gr.xxv 

Alcohol  absolut   .    . 

.  m>=''^- 

Aq.  destillatas  .    .    . 

•  m- 

01.  menthce  pip    .    . 

•  mv 

Misce  et  filtra. 

194 


DENTAL   MEDICINE. 


SiGNA. — As  an  injection  in  pockets  of 
gum. 

A  Disinfectant  Mouth    Wash. 
Dr.  J.  B.  Patrick. 
R  .    Acidi  carbolici  (cryst.), 
Glycerini, 

AquEe  rosse aa  ^^ij.    M. 

SiGNA. — Five  to  eight  drops  in  a  wine- 
glass of  water. 

A  Stimulant  and  Antiseptic  Mouth 
Wash. 
R.    Acidi  carbolici    .    .    .  gtt.xx 

Glycerini ,^iv 

Aquse ^x.        M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Fetid  Perspiration. 
Ijt; .    Acidi  carbolici    ...  2  parts 

Glycerini 3  parts    M. 

Fo7'  Parasitic  Skin  Diseases. 

R.    Acidi  carbolici    ..-31 

Glycerini |j.        M. 

Antiseptic    Solution  for   Washing  and 
Spraying   Wounds.^  etc. 

R  .    Acidi  carbolici  (cryst.)  partem  j 
Aquae part.   xxiv. 

SiGNA. — Dilute  the  above  solution  with 
equal  parts  of  water,  which  will  make 
it  equal  to  i  part  of  the  acid  to  40 
parts  of  water ;  also  for  use  in  disin- 
fecting instruments  and  sponges. 

For  Dry  Mouth. 
H.  J.  Fish. 
R.    Acidi  carbohci     .    .    .  gtt.x 

Glycerini ^j.         M. 

SiGNA. — Apply  on  palate  of  mouth  with 
a  soft  brush  3  times  a  day. 

For   Inhalation  in    Syphilitic   Ulcera- 
tions. 
R.    Acidi  carbolici     .    .    .   ,^xxj 

Aqua  destillatae    .    .    .  ^:^iij       M. 
SiGNA. — Inhale  the  vapor.     Antiseptic. 


A  Stimulant  and  Antiseptic  Injection. 

R .    Acidi  carbolici  .        ,     l  part 

Glycerini 30  parts.  M. 

Useful  as  an  injection  in  chronic  forms 
of  alveolar  abscess. 

For  Odontalgia. 

R .     Acidi  carbolici, 
Chloroform, 
Liquid  opii, 
Vel    morphine    hydro- 

chloratis aa  gij 

Tirffcturas  benzoini    .    .  ^j.         M. 
S.   Apply  to  exposed  surface  of  pulp, 
on  cotton. 

A  Stimula7it  and  Antiseptic  Lotio7i  or 
Injection. 

Percy  Boulton. 
R.    Acidi  carbolici    .    .    .  TTLvj 
Tincture  iodi    ....  Tttxlv 

Glycerini ^j 

Aquse  destillatae  .  .  .  ^v.  M. 
For  inflamed  mucous  membrane,  and 
an  injection  for  chronic  alveolar  ab- 
scess ;  also  useful  in  acute  abscess  after 
the  use  of  more  powerful  escharotic  and 
antiseptic  agents. 

For  Itching  of  the  Skin. 

R.    Acidi  carbolici     .    .    .   ^ij 

Glycerini ^j 

Aquse  rosae ^^'ij-    ^• 

SiGNA. — To  be  applied  by  means  of  a 
sponge. 

The  following  preparation  is  recom- 
mended for  the  relief  of  odontalgia,  by 
Dr.  K.  W.  Millican  :— 

"  Melt  white  wax  or  spermaceti,  two 
parts,  and  when  melted  add  carbolic 
acid  crystals,  one  part,  and  chloral 
hydrate  crystals,  two  parts ;  stir  well  till 
dissolved.  While  still  liquid,  immerse 
thin    layers    of    carbolized    absorbent 


CHROMIC   ACID. 


195 


cotton-wool,  and  allow  them  to  dry. 
When  required  for  use,  a  small  piece 
may  be  cut  off  and  slightly  warmed, 
when  it  can  be  inserted  into  the  carious 
cavity  of  the  tooth,  where  it  will 
solidify." 

For    Alveolar   Pyorrhoea    {^Riggs' 
Disease). 

R .    Acidi  carbolici     .    .    .  X([y 

Spts.  vini  rectif.  .    .    .  ^vj 

Aq,  menthss  pip  .    .    .  3  ij 

01.  anisi '\(\j 

01.  cinnamon    ....  TlXss.      M. 

SiGNA. — Apply  to  gum  with    camel's- 
hair  brush. 

Afi  Antiseptic  and  Disinfectant 
Dentifrice. 


For  Chilblains. 


R. 


J.  Stocken. 

Acidi  carbolici    . 

.  .  iTLxxx 

Pulvis  ossis  sepise 

.    .  3iJ 

Pulvis  radicis  iridis 

•  ^ij      . 

Creta  preparatse  . 

.^"J 

Olei  caryophylli  ,    . 

•  gtt.uj. 

M. 


R. 


For  a   Carbolized  Styptic. 
Acidi  carbolici     .    .  x  parts 


Collodii c  parts 

Acidi  tannic!     .    .    .  v  parts 
Acidi  benzoici  .    .    .  v  parts.     M. 
It  coagulates    blood    and   albumen, 
and  cicatrizes  the  tissues. 


R. 


Acidi  carbolici 
Tincture  iodi  . 
Acidi  tannici  . 
Cerate  simplicis 
Fiat  unguentum. 


3J 


M. 


For  Odontalgia. 
R.    Collodii  (flexile)  .    .    .  3J 

Acidi  carbolici    .    .    .  gij.        M. 
SiGNA. — Apply  to  surface  of  exposed 
and  painful  pulp. 

For   Odontalgia. 
R.    Acidi  carbolici     .    .    .   ,!^ij 

Morphinse  acetatis   .    .  gr.xx.     M. 
SiGNA. — Apply  to  surface  of  exposed 
pulp,  on  cotton. 
Dressing  for   Root-Canals   and 
Abscesses. 
Dr.  G.  V.  Black. 
R .    Acidi  carbolici    .    .  i  part 
Oleum  cassias   ...  2  parts 
Oleum  gaultherise    .  3  parts.      M, 

Dressing  for  Childre7i\   Teeth. 
Dr.  L.  L.  Davis. 
R.    Acidi  carbolici  (cryst.)    ^j 
Oleum  cassise   .    .    .    .   ^j 
Glycerini  .    .  .    .  ^j 

Alcoholis ^ij.       M. 

It  quickly  relieves  pain,  and  does  not 
nauseate. 


For  Pain  after  Extraction. 
First  wash  out  cavity  with  phenol-sodique,  then  apply  on  a  loosely  rolled 
pellet  of  cotton  the  following  : 

R.         Acid,  carbolici.   glacial jij 

Liq.  potassee gj 

Water ^vj.  M. 

ACIDUM    CHROMICUM— CHROMIC   ACID. 
Formula. — Yi.^xO^. 

Derivation. — Chromic  Acid  is  obtained  in  the  form  of  bril- 
Hant,  deep  red,  acicular  crystals,  by  the  reaction  of  strong  sul- 


196  DENTAL   MEDICINE. 


phuric  acid  upon  a  solution  of  bichromate  of  potash.  It  is 
deliquescent,  and  very  soluble  in  water  and  alcohol,  forming 
an  orange-yellow  solution. 

Medical  Properties  and  Action. — It  is  a  powerful  caustic,  de- 
composing the  tissues  by  rapid  oxidation  ;  and  although  it  is 
very  slow  and  gradual  in  its  action,  yet  it  is  deeply  penetrat- 
ing and  when  action  ceases,  sesquioxide  of  chromium  remains. 
So  destructive  is  its  effect,  that  small  animals  are  dissolved 
entirely,  bones  and  all,  by  it,  in  fifteen  or  twenty  minutes.  On 
account  of  its  penetrating  deeply,  without  much  pain,  care  is 
necessary  in  its  use ;  and  when  used  as  a  caustic,  the  sur- 
rounding tissues  should  be  well  protected.  The  part  on  which 
it  acts  first  becomes  yellow,  then  brown,  and  ultimately  black, 
and  the  eschar  is  detached  in  from  twenty-four  to  forty-eight 
hours.  It  is  a  powerful  oxidizer,  and  gives  up  its  oxygen 
readily  to  organic  matter,  which  it  thus  dissolves.  When  in 
solution,  more  or  less  diluted,  its  action  can  be  modified, 
according  to  the  effect  desired. 

Therapeutic  Uses. — Chromic  acid  is  not  given  internally.  In 
the  form  of  paste,  or  solution  with  Water,  it  is  a  valuable 
caustic  in  cancerous  and  other  ulcerations,  malignant  growths, 
hemorrhoids,  warts,  etc.  Chromic  acid  has  been  employed 
with  good  effect  in  syphilitic  sores,  cases  of  secondary  syphilis, 
deep  and  jagged  ulcers  of  the  tongue,  and  ulceration  of  inside 
of  the  cheek,  mucous  tubercles  and  condylomata.  It  has  also 
been  employed  in  the  treatment  of  granular  ophthalmia,  uterine 
hemorrhaege,  uterine  catarrh,  etc.  It  causes  less  pain  than 
nitric  acid  and  other  caustics,  and  should  never  be  applied  to 
a  surface  to  be  cauterized  in  a  layer  deeper  than  a  line  in  thick- 
ness. For  removal  of  warts,  etc.,  it  is  employed  in  a  solution 
of  100  grains  to  the  ounce  of  distilled  water. 

Dental  Uses. — In  dental  practice  chromic  acid  has  been 
employed  for  obtunding  sensitive  dentine ;  but  its  most  valu- 
able application  is  for  the  removal  of  tumors  and  morbid 
growths  upon  the  gums,  fungous  growths  of  tooth  pulp,  etc. 
When  applied  to  any  part  of  the  mouth,  the  surrounding  parts 
should   be   carefully   protected   by   folds  of  lint  or   strips  of 


GALLIC   ACID.  197 


adhesive  plaster.  A  glass  rod,  or  a  gold  or  platinum  wire 
should  be  used  for  its  application.  It  is  also  useful  in  ulcera- 
tion and  recession  of  the  gums,  beginning  the  treatment  with 
a  weak  solution,  and  gradually  increasing  the  strength.  It  is 
sometimes  combined  with  glycerine,  in  which  case  the  latter 
must  be  added  to  the  acid  drop  by  drop,  in  order  to  avoid 
explosion. 

DENTAL   FORMUL/E. 

For    Secondary    Syphilitic     Ulcers,    and     Ulceration    of   Mticous 

I\Icmbrane  of  Mouth  and  Tongue. 

R.        Acidi  chromici gr.x 

Aqua; §j.         M. 

SiGNA. — Paint  the  diseased  parts  3  or  4  times  a  day,  with  a  camel's- 
hair  brush  dipped  in  the  solution. 

CRESOL— CRESYLIC   ACID— ACIDUM   CRESYLICUM. 

Fonmila.—C^Yif)  =  C6H,(CH3).OH. 

Cresylic  Acid  is  an  antiseptic  and  germicide  upon  the  differ- 
ent kinds  of  pathogenic  organisms.  It  is  a  colorless  liquid 
having  the  odor  of  creasote.  It  boils  at  203*^,  and  is  slightly 
caustic.  It  is  soluble  in  water,  quite  soluble  in  alcohol,  gly- 
cerine, and  water  of  ammonia,  and  very  soluble  in  both.  When 
injected  into  rabbits  it  produced  toxic  symptoms,  but  to  cause 
death  a  dose  four  times  greater  than  that  of  carbolic  acid  was 
required.  It  has  a  marked  effect  in  retarding  the  fermentation 
of  urine  and  milk.  Experiments  on  cultures  of  the  various 
pathogenic  micro-organisms  demonstrated  that  cresylic  acid  is 
a  powerful  antiseptic  and  germicide,  and  quicker  in  its  action 
than  carbolic  acid  or  its  congeners. 

ACIDUM  GALLICUM— GALLIC  ACID. 

Formula. — C^HgOg. 

Derivation. — Gallic  Acid  is  obtained  from  galls  by  exposing 
the  powder,  in  water,  to  the  action  of  the  air,  at  a  temperature 
of  between  60°  and  70°  F,,  when  the  acid  is  deposited  in  the 
form  of  small,  silky,  almost  colorless  crystals,  possessing  a 
slightly  acid  and  astringent  taste.  Gallic  acid  is  slightly 
soluble  in  cold  water,  and  freely  soluble  in  hot  water,  gly- 
cerine or  alcohol. 


198  DENTAL  MEDICINE. 


Galls,  from  which  gallic  acid  is  prepared,  are  the  excres- 
cences caused  by  the  punctures  and  deposited  ova  of  a  hy- 
menopterous  insect  on  the  twigs  of  the  gall  oak  {Quercus 
Infectorid). 

Source. — Galls  are  obtained  from  Asia  Minor  and  Persia. 

Medical  Propei'ties  and  Action  of  Galls. — Powerfully  astrin- 
gent, this  property  depending  upon  the  presence  of  tannic  and 
gallic  acids,  as  they  contain  35  per  cent,  of  tannic  and  5  per 
cent,  of  gallic  acids.  The  powder,  which  is  obtained  from  the 
small,  round,  dark-blue  or  lead-colored  excrescences,  is  of  a 
light  yellowish-gray  color,  inodorous  and  of  a  bitter  taste. 

Galls  are  used  in  various  forms,  such  as  powder,  tincture, 
infusion,  ointment,  etc. 

Therapeutic  Uses. — Galls  are  employed  in  the  treatment  of 
chronic  diarrhoea,  dysentery,  leucorrhoea,  chronic  gonorrhoea 
and  gleet,  diseases  of  the  uterus  and  intermittent  fevers,  and 
externally  in  hemorrhagic  disorders,  hemorrhoids,  relaxation 
of  uvula,  hypertrophy  of  the  tonsils,  etc. 

Gallic  acid  is  given  directly  for  internal  hemorrhage. 

Dose. — Of  powdered  galls,  gr.  x  to  gr,  xx.  The  ointment 
is  composed  of:  powdered  galls,  gr.  Ixxx;  benzoated  lard,  Ij. 
It  is  combined  with  opium  in  the  proportion  of  ointment  of 
galls,  ij ;  powdered  opium,  gr.  xxxij. 

Medical  Properties  and  Action. — Gallic  acid  is  a  powerful 
astringent  for  arresting  hemorrhage  in  which  the  bleeding 
vessels  must  be  reached  through  the  circulation.  It  is  also  a 
valuable  styptic  in  cases  of  hemorrhage  depending  on  a  hem- 
orrhagic diathesis,  and  in  the  form  of  a  gargle  it  is  very  ser- 
viceable in  acute  inflammations  of  mucous  membranes.  It  is 
also  a  strongly  deodorizing  agent ;  and,  like  tannic  acid,  it  is 
capable  of  taking  oxygen  from  the  globules.  Internally  em- 
ployed it  produces  constipation,  which  may  be  prevented  by 
an  occasional  aperient.  Although  it  is  weaker  than  tannic 
acid,  yet  its  properties  are  very  similar.  It  is  supposed  to  be 
converted  into  tannic  acid  in  the  blood. 

Therapeutic  Uses. — Gallic  acid  is  employed  in  the  treatment 
of  hemorrhagic  diseases,   in  their  chronic   stages  especially, 


GALLIC  ACID.  199 


such  as  haemoptysis,  hemorrhage  from  ulcer  of  the  stomach, 
haematemesis  and  hsematuria,  atonic  menorrhagia ;  also,  for 
the  profuse  perspirations  and  excessive  expectoration  of  phthisis, 
for  albuminuria,  dyspepsia,  chronic  diarrhoea  and  gastric  irri- 
tation in  children,  gonorrhoea,  gleet,  etc. 

Dose. — Of  gallic  acid,  gr.  ij  to  gr.  v,  in  pill,  every  two  or 
three  hours. 

Glycerite  of  gallic  acid  [Glyceritiun  Acidi  Gallici),  for  ex- 
ternal use,  is  composed  of  gallic  acid,   §j ;  glycerine,  5iv. 

Ointment  of  galls  {Unguentum  Galled)  is  composed  of  galls 
in  fine  powder,  o  j ;  lard,  420  grains. 

Dental  Uses. — Powdered  galls  is  useful  as  a  styptic  in  super- 
ficial hemorrhages  from  the  gums  and  mucous  membrane ; 
also  in  inflamed  and  ulcerated  conditions  of  mucous  membrane, 
and  in  relaxation  of  the  uvula.  Gallic  acid,  in  the  form  of  a 
gargle,  is  employed  in  acute  inflammations  of  mucous  mem- 
brane, as  astringent  and  antiseptic,  and  in  hemorrhages  from 
mucous  surfaces  depending  upon  a  hemorrhagic  diathesis. 

For  hemorrhage  following  the  extraction  of  teeth,  Dr.  Bar- 
tholomew claims  that  one  teaspoonful  of  gallic  acid  in  a  glass 
of  water,  internally  administered,  never  fails. 

DENTAL  FORMULA. 

Fo7-  Acute    Tonsilitis   and   Injlatnma- 

tion  of  the  Mucous  Membrane  An    hiternal    Asti'ingent    in    He)iior- 

of  the  Mouth.  rhagic  Affections. 

R.    Acidi  gallici    ....  gr.xl  R .    Acidi  gallici    .    .    .    .  ^j 

Liq.  sodae  chlorinatje  .   ^  ij  Glj'cerini ^  iv 

Glyceiini 2i'j  Aquae  destillatee  .    .    .   5VJ.       M. 

Aquse  destillatse  .    .    .  5viij.     M.  Signa. — Take  ^j  as  a  dose. 

SiGNA. — To   be  used  as  an  antiseptic 

and  astringent  gargle. 

A71   Internal   Astringettt  for   Dental 

For  Relaxation  of  Uvula  and  Hyper-  Hemorrhage. 

trophy  of  Tonsils.  ,,  . 

^  -^    -'  Otto  Arnold. 

R.    Infusi    gallae     .    .    .    .   gvj  R.    Acidi  gallici     .    .    .    .   ^j 

Aluminis gr.xl.      M.  Aquce  cinnamon  .    .    .   gij.        M. 

SiGNA. — Use  as  a  gargle.  Signa. — A  teaspoonful  every  hour  until 

bleeding  is  arrested. 


200  DENTAL  MEDICINE. 


For  an  Astringent  Gargle  or  Lotion. 

R  .        Pulveris  gallae §  ss 

Aquae Oj.  M. 

SiGNA. — As  a  gargle  or  lotion  in  inflamed  or  ulcerated  condition  of 
mucous  membrane  and  gums. 

ACIDUM   HYDROBROMICUM— HYDROBROMIC  ACID. 

Formula. — H  Br. 

Derivation. — Diluted  Hydrobromic  Acid  is  prepared  by 
adding  ten  per  cent,  of  absolute  hydrobromic  acid  to  ninety 
per  cent,  of  water.  It  is  a  clear,  colorless  liquid,  having  no 
odor,  but  a  decidedly  acid  taste  and  an  acid  reaction. 

Medical  Properties  and  Therapeutic  Uses. — Hydrobromic 
acid  is  often  substituted  for  the  bromides  on  account  of  its 
possessing  many  of  their  properties.  It  is  employed  in  cere- 
bral disorders  from  over-exertion,  epilepsy,  spasmodic  cough, 
angina  pectoris,  affections  of  the  heart,  as  it  diminishes  its 
action,  to  relieve  the  symptoms  of  quinine,  and  also  of  mor- 
phine, migraine  or  sick  headache,  neuralgia,  spasmodic  asthma, 
etc. 

Dose. — TTLxx  to  3ij. 

Dental  Uses. — Diluted  Hydrobromic  Acid  may  be  employed 
in  facial  neuralgia,  infantile  convulsions  due  to  teething,  and 
to  lessen  the  irritability  of  the  fauces  when  impressions  for 
obturators  and  artificial  palates  are  being  taken. 

ACIDUM  HYDROCHLORICUM— HYDROCHLORIC  ACID. 
MURIATIC  ACID— ACIDUM  MURIATICUM. 

Formida. — HCl.     Sp.  gr.,  1.16. 

Derivation. — Hydrochloric  or  Muriatic  Acid  is  obtained  by 
the  action  of  sulphuric  acid  on  a  solution  of  chloride  of  sodium 
or  common  salt.  When  pure,  it  is  a  transparent,  colorless 
liquid,  but  when  contaminated  with  chlorine,  iron  and  other 
substances,  it  has  a  yellow  color.  It  emits  a  dense,  white 
vapor,  with  a  pungent  odor  and  a  corrosive  taste,  being  an  ac- 
tive poison.     The  antidote  is  magnesia  or  soap. 

Medical  Properties  and  Action. — The  strong  acid  is  a  power- 
ful caustic  and  escharotic  ;  also  disinfectant  and  fumigant,  but 
inferior  in  its  disinfectant  properties  to  those  of  chlorine.  For 
internal  use  the  dilute  acid,  which  is  tonic,  refrigerant  and  as- 


HYDROCHLORIC  ACID.  201 

tringent,  is  employed,  acidum  hydrochloricum  dilutum — 
diluted  hydrochloric  acid,  which  is  prepared  by  diluting  the 
strong  acid  so  that  four  ounces  of  the  acid  are  contained  in  a 
pint  of  diluted  acid.  It  is  of  a  deep  yellow  color,  and  emits 
the  odor  of  chlorine,  which  is  its  principal  constituent. 

TJierapeutic  Uses. — The  dilute  hydrochloric  acid  is  internally 
employed  in  the  treatment  of  calculous  affections,  gout,  atonic 
dyspepsia,  typhus  and  typhoid  fevers,  continued  fevers  of  child- 
hood, syphilis,  chronic  whooping  cough,  phthisis,  etc.,  and 
externally  in  diphtheria,  ulcerated  sore  throat,  cynanche  ma- 
ligna, etc. 

Dose. — Of  dilute  hydrochloric  acid,  TTlx  to  TTLxxx,  freely 
diluted ;  otherwise,  when  swallowed,  it  is  highly  irritant  and 
corrosive. 

Dental  Uses. — The  strong  acid  is  employed  in  the  dental 
laboratory  for  dissolving  zinc,  in  the  preparation  of  flux  for 
soldering  certain  metals. 

The  strong  acid  is  also  employed  as  a  local  application  in 
gangrenous  stomatitis  or  crancrum  oris,  for  arresting  the  ulcer- 
ative process;  but  care  is  necessary  in  its  use,  on  account  of  its 
powerful  action,  in  order  to  limit  its  application  to  the  parts 
on  which  it  is  to  act.  In  mild  cases  it  should  be  diluted  with 
an  equal  weight  of  honey. 

In  aphthous  ulcerations  of  the  mouth,  in  children,  it  is  often 
a  useful  application. 

DENTAL   FORMULA. 
For  Aphtha.  For  Ulceration  of  Mucous  Membrane. 

R .    Acidi  hydrochlorici  .  i  part  R  .    Acidi  hydrochlorici  di- 

Mellis 8  parts.      M.  luti 5  ij 

SiGNA. — Apply     with      a     camel-hair  Glycerini '^'w 

pencil.  Aquae  destillatEe  .    .    .  ^x.        M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Chronic  InJJaviniation  of  Mucous  For  Scorbutic  Gums. 

Membrane  and  Gums.  ti        a-i-i     ^       11     --j- 

ii. .    Acidi  hydrochlorici  di- 

R.    Acidi  hydrochlorici  di-  luti ^ss 

hit TTlx  Mellis, 

Infusi  cinchonae  .    .    .  f^iv  Aquje  rosse     ....  aa  f5J.     M. 

Mellis 15  j.  M.       SiGNA. — Apply  with  a  camel-hair  pencil 

Fiat  gargarysma.  3  or  4  times  a  day. 


202  DENTAL   MEDICINE. 


ACIDUM   NITRICUM— NITRIC   ACID. 
AQUA  FORTIS. 

Fonmtla. — HNO3.     Sp.  gr.,  1.420. 

Derivation. — Nitric  acid  is  obtained  by  the  action  of  sul- 
phuric acid  upon  nitrate  of  potash  or  soda.  When  strong  and 
pure  it  is  colorless,  but  on  account  of  the  presence  of  nitric 
peroxide  it  is  generally  of  a  yellow  color,  and  emits  acrid, 
corrosive  fumes. 

Medical  Properties  and  Action. — Pure  nitric  acid  is  a  power- 
ful caustic  and  escharotic,  and  leaves  a  permanent  stain  on  the 
cuticle.  It  is  not  employed  in  its  concentrated  form  internally, 
but  externally,  as  an  escharotic  to  destroy  warts  and  stimulate 
sluggish  sinuses ;  in  a  diluted  form  it  is  employed  as  an  as- 
tringent wash  or  gargle.  The  antidotes  in  cases  of  poisoning 
are  magnesia  or  soap,  and  mucilaginous  drinks. 

Therapeutic  Uses. — The  strong  acid  is  employed  externally 
in  hospital  gangrene,  and  phagedenic  ulcerations;  hemor- 
rhoids and  painful  hemorrhoidal  tumors,  syphilitic  condylo- 
mata, syphilitic  sore  throat,  malignant  ulcers,  obstinate  skin 
diseases,  etc. 

Diluted  Nitric  Acid. — Acidiun  Nitricuni  Dihitnni  con- 
tains three  ounces  of  acid  in  a  pint  of  the  diluted  acid. 

Medical  Properties  and  Action. — It  is  an  antalkaline,  alter- 
ative, tonic  and  refrigerant,  and  has  a  very  direct  action  on 
the  liver,  and  if  its  use  is  continued  for.  a  long  time  it  causes 
salivation.  Like  all  mineral  acids,  it  injures  the  teeth  ;  hence, 
proper  care  should  be  taken  to  prevent  such  action,  such  as 
the  use  of  alkaline  gargles  before  and  after  taking  the  acid 
into  the  mouth,  which  should  be  done  through  a  glass  tube  or 
quill.  As  a  tonic  it  is  advantageously  employed  during  con- 
valescence and  inflammation,  and  in  cachexia  following  acute 
disease  or  habits  of  intemperance.  It  is  also  employed  as  an 
alterative  after  a  long  use  of  mercury,  as  it  increases  the 
strength  and  improves  the  tone  of  the  system.  It  is  also  val- 
uable as  a  disinfectant,  but  inferior  to  chlorine.  It  is  not  as 
agreeable  to  the  stomach  as  diluted  sulphuric  acid. 


PHOSPHORIC  ACID.  203 


Therapeutic  Uses. — Dilute  nitric  acid  is  employed  in  the 
treatment  of  calculous  disease,  syphilis,  chronic  hepatitis, 
chronic  diarrhcea,  constipation,  chronic  affections  of  the  spleen, 
chronic  rheumatism,  cardialgia,  whooping  cough,  intermittent 
fevers,  etc. 

Dose. — Of  diluted  nitric  acid,  gtt.  ij-xv,  three  times  a  day, 
diluted  with  water. 

Dental  Uses. — The  strong  acid,  when  mixed  with  two  parts 
of  hydrochloric  acid,  is  a  solvent  for  gold,  and  is  known  as 
aqua  regia.  It  is  also  employed  as  one  of  the  most  effectual 
caustics  in  cancrum  oris,  the  constitution  being  supported  and 
quinine  given  at  the  same  time ;  also  for  malignant  ulcers  of 
the  mouth,  and  for  devitalizing  pulps  of  teeth  when  nearly  ex- 
posed by  mechanical  abrasion,  care  being  observed  that  the 
part  of  the  surface  immediately  over  the  pulp  is  touched  with 
the  acid,  and  the  neighboring  parts  protected. 

DENTAL  FORMULA. 
For  Sloughing  and  Ill-Conditioned  Ulcers. 

R.        Acidi  nitrici TTLl-lx 

Aquae Oj.  M. 

SiGNA. — Apply  with  a  camel-hair  brush. 

ACIDUM   PHOSPHORICUM— PHOSPHORIC   ACID. 

AciDUM  Phosphoricum  Dilutum. — Diluted  Phosplwric  Acid 
is  the  principal  form  in  which  phosphoric  acid  is  employed  in 
medicine. 

Forimda. — H3PO4.     Sp.  gr.,  1.056. 

Derivation. — Phosphorus,  a  non-metallic  element,  obtained 
■from  bones,  is  a  translucent,  nearly  colorless,  wax-like  solid, 
without  taste,  and  emitting  white  vapors  when  exposed  to  the 
air.     Sp.  gr.,  1.8. 

It  is  insoluble  in  water,  but  soluble  in  ether  and  in  hot  oil 
of  turpentine,  and  has  a  peculiar  smell.  It  is  nervine,  tonic 
and  stimulant  and  in  over-doses,  poisonous.  The  vapor  is 
irritating  to  the  conjunctiva  and  bronchial  mucous  membrane. 

Diluted  Phosphoric  Acid  is  prepared  by  boiling  phosphorus 
with    nitric    acid    and    distilled    water    until    it    is    dissolved. 


204  DENTAL   MEDICINE. 

evaporating  and  re-diluting  it.  It  may  also  be  obtained 
by  dissolving  an  ounce  of  glacial  phosphoric  acid  in  three 
ounces  of  distilled  water,  afterwards  adding  forty  grains  of 
nitric  acid,  boiling  to  a  syrup,  and  diluting  with  water  until 
the  solution  measures  twelve  and  a  half  ounces. 

Medical  Properties  and  Action. — It  is  tonic  and  refrigerant, 
and,  in  large  doses,  is  a  powerful  stimulant  to  the  nervous  and 
vascular  systems.  It  can  be  detected  in  the  blood,  owing  to 
its  absorption,  and,  in  large  doses,  is  an  irritant  poison. 

Therapeutic  Uses. — Diluted  phosphoric  acid  is  employed  in 
scrofula,  dropsy,  haemoptysis,  calculous  disease,  diabetes  and 
cardialgia.  Externally,  it  has  been  employed  as  a  local  appli- 
cation in  the  treatment  of  caries  of  the  bones  and  osseous 
tumors. 

Dose. — Of  dilute  phosphoric  acid,  gtt.  ij-xv,  diluted  in  sugar 
and  water. 

Dental  Uses. — As  a  local  application  in  the  treatment  of 
caries  of  the  maxillary  bones  and  osseous  tumors  of  the  jaws. 
Internally,  it  has  been  administered  with  a  view  of  supplying 
a  deficiency  of  phosphoric  acid  in  the  teeth.  [See  Hypophos- 
phites  of  Lime). 

DENTAL  FORMULA. 

I^or  Caries  of  the  Maxillary  Bones  and  For  Ulcers   Over   Carious  Bones. 

Osseous   Tu7?iors  of  the  Jaw.  ^^        »    •  j  •     i.       i,     •  •     i 

J  ->  ]j^ .    Acidi  phosphonci  gla- 

R.    Acidi  phosphor,  dilut.  .  i  part  cialis gj 

Aquje  destillatas  .  8  to  lo  parts.  M.  Aquas  destillatse  .    .    .  fgviij 

SiGNA. — Apply    as    a    lotion    or  injec-  Fiat  solutio. 

tion.  SiGNA. — To  be  applied  on  compresses 

to  ulcers  situated  over  carious  bones. 

Phosphoric  Acid  in  the  anhydrous  state  consists  of  one 
equivalent  of  phosphorus  to  five  equivalents  of  oxygen  (PO5), 
and  it  is  obtained  by  the  direct  union  of  its  constituents,  which 
takes  place  when  phosphorus  is  burned  in  perfectly  dry  oxy- 
gen gas. 

Thus  procured  it  is  in  the  form  of  a  white  amorphous 
powder,  extremely  deliquescent,  volatilizable  at  a  red  heat,  and 
assumes,  when  it  cools,  after  fusion,  a  vitreous  appearance. 

Glacial  Phosphoric  Acid,  or  monohydrated  phosphoric  acid, 


PHOSPHORIC  ACID.  205 


is  readily  obtained  from  calcined  bones,  by  first  heating  them 
with  sulphuric  acid,  which  produces  an  insoluble  superphos- 
phate of  lime;  then  dissolving  out  the  latter  salt,  and  saturating 
it  with  carbonate  of  ammonia,  which  generates  phosphate  of 
ammonia  in  solution,  and  finally  obtaining  the  phosphate  of 
ammonia  by  evaporating  it  to  dryness,  and  then  igniting  it  in  a 
platinum  crucible.  The  ammonia  and  all  of  the  water,  except 
one  equivalent  for  each  equivalent  of  the  acid,  are  driven  off, 
and  the  glacial  phosphoric  acid  remains,  the  formula  of  which 
is  HO.POg,  and  contains  11.2  percent,  of  water.  It  is  a  white, 
transparent  fusible  solid,  generally  in  the  form  of  sticks,  inodor- 
ous and  sour  to  the  taste.  It  slowly  deliquesces,  and  is  spar- 
ingly soluble  in  water,  but  freely  soluble  in  alcohol. 

Dental  Uses. — Glacial  phosphoric  acid  and  white  oxide  of 
zinc  formed  into  an  anhydrate,  give  the  plastic  material  for 
filling  teeth,  known  as  oxyphosphate  of  zinc.  The  powder  or 
solid  portion  of  this  preparation  is  prepared  by  packing  pure 
oxide  of  zinc  in  a  clay  crucible  and  subjecting  it  to  almost  a 
white  heat  for  two  hours,  when  it  will  have  been  reduced  in 
bulk  fifty  per  cent.  It  is  then  pulverized  in  a  mortar  to  an 
almost  impalpable  powder.  The  burning  of  the  oxide  of  zinc 
colors  it  to  a  light  yellow,  and  it  is  now  in  a  condition  for  use, 
and  may  be  kept  in  a  covered  vessel  for  any  length  of  time. 

The  liquid  portion  of  this  filling  material  being  glacial  phos- 
phoric acid,  is  prepared  by  dissolving  the  acid  in  pure  water 
until  a  saturated  solution  is  obtained,  when  it  is  reduced  by 
boiling  in  a  glass  vessel  until  it  is  of  the  consistency  of  gly- 
cerine, in  which  operation  it  loses  one-third  in  bulk.  It  is  now 
ready  for  use,  and  must  be  kept  in  a  close  glass-stoppered  bottle. 

Formula  for  Fletcher's  and  Weston's  preparations  of  oxy- 
phosphate of  zinc  filling  materials: — 

FLETCHER'S. 
Fluid.  Solid. 

Phosphoric  acid.  Basic  oxide  of  zinc. 

Phosphate  of  alumina. 

WESTON'S. 
Fluid.  Solid. 

Phosphoric  acid.  Basic  oxide  of  zinc — 80  per  cent. 

[See  Oxide  of  Zinc.)  Sihcate  of  alumina — 20    "     " 


206  DENTAL  MEDICINE. 


Medicated  Oxyphosphate  Fillings. — Dr.  Chas.  B.  Atkinson 
claims  the  following  advantages  for  such  filling  materials  : 

First, — A  remedial  agent  in  constant  contact  with  the  walls 
of  the  cavity. 

Second. — Germicidal  action  of  the  filling  on  the  tissue  with 
which  it  comes  in  contact. 

Third. — A  neutral  influence  resisting  solution. 

Fourth. — Increased  hardness,  varying  somewhat  with  the 
agent  used.  The  medicaments  for  oxyphosphate  fillings  are : 
I.  Creasote  and  oil  of  cloves,  equal  parts;  2.  Eugenol ;  3. 
Deliquesced  Carbolic  acid;  4.  Oil  of  cinnamon;  5.  Oil  of 
cloves;  6.  Creasote,  pure  ;  7.  Creasote,  oil  of  cloves  and  iodo- 
form ;  8.  Creolin  ;  9.  Campho-phenique  ;  10.  Potassium  chlo- 
rate (powdered) ;  ii.  Salicylic  acid  ;  12.  Camphor  (pulverized) ; 
13.  Stick  sulphur  (pulverized) ;  14.  Iodoform  ;  15.  Oil  of  win- 
tergreen.  The  first  seven  have  been  fairly  tested  by  Dr.  At- 
kinson and  were  found  to  be  equal  in  durability,  manipulative 
quahties  and  time  of  setting.  He  employs  them  also  in  re- 
taining inlays,  in  setting  retaining-fixtures  in  pyorrhea  cases, 
in  setting  crowns,  etc.  In  capping  pulps  he  always  employs 
a  mixture  of  oxide  of  zinc,  creasote  and  oil  of  cloves,  and  adds 
a  remedial  agent  to  the  oxyphosphate  filling.  He  employs 
mostly  the  first  named  on  the  list.  If  the  mendicament  is  a 
liquid  he  adds  about  an  equal  quantity  of  the  medicament  and 
phosphoric  acid  ;  if  a  powder,  about  equal  parts  of  the  medi- 
cament and  oxide.  The  proportions  may  be  varied  as  re- 
quired.    The  average  time  of  setting  is  about  ten  miputes. 

ACIDUM  SALICYLICUM— SALICYLIC  ACID. 

Formula.— Z^'A^O^,  or  HC7H5O3  or  CeHjcSoa}. 

Derivation. — Salicylic  Acid  is  obtained  by  combining  car- 
bolic acid  with  caustic  soda,  and  subjecting  this  compound  to 
dry  carbonic  acid  under  the  influence  of  heat,  the  portion  of 
salicylate  of  sodium  remaining  behind  after  the  carbolic  acid 
distills  over  being  saturated,  in  the  form  of  a  hot,  aqueous 
solution,  with  muriatic  acid,  which  liberates  the  salicylic  acid 
in  small  crystals.     The  crystals  are  washed,  dissolved  in  hot 


SALICYLIC  ACID.  207 


water,  and  by  re-crystallization,  obtained  in  the  form  of  a 
powder  of  a  light  brown  color,  which  is  then  bleached  until 
it  is  quite  white;  but  most  of  that  sold  is  of  a  light  cream- 
color  with  a  reddish  tinge.  The  coloring  matter,  however, 
which  is  present,  does  not  interfere  with  its  efficacy.  It  has 
no  smell,  a  slight  taste  and  is  soluble  in  alcohol  and  ether 
and  in  hot  water  and  glycerine.  It  can  also  be  obtained  from 
salicin,  the  vegetable  principle  existing  in  willow,  poplar,  etc., 
and  from  oil  of  gaultheria  (winter  green)  and  from  spiraea 
ulmarise  (meadow  sweet). 

Medical  Properties  and  Action. — Salicylic  acid  is  a  powerful 
antiseptic,  and  is  said  to  be  as  effective  in  small  quantities  as 
any  other  antiseptic,  in  arresting  the  putrefactive  and  fermen- 
tative process.  When  properly  reduced  in  strength,  it  causes 
no  pain  or  irritation  in  the  parts  to  which  it  is  applied.  It 
will  destroy  minute  organisms,  and  a  small  quantity  will  arrest 
vinous  fermentation  and  prevent  the  decomposition  of  animal 
fluids.  Although  free  from  any  poisonous  action  when 
administered  in  a  reasonable  quantity,  yet  in  large  doses  it  will 
cause  nausea  and  vomiting.  It  is  thought  to  combine  with 
the  soda  of  the  blood,  where  it  is  present  as  a  salicylate.  It 
has  little  or  no  affinity  for  cold  water ;  but  the  addition  of  cer- 
tain alkaline  salts,  such  as  sodium  phosphate,  increases  its 
solubility.  Combined  with  sulphite  of  sodium,  which  is  also 
antiseptic,  and  water,  a  solution  is  formed  which  is  free  from 
irritating  properties,  and  especially  applicable  to  the  treatment 
of  zymotic  diseases.  Glycerine  warmed  will  dissolve  -dV  its 
weight  of  salicylic  acid,  and  the  solution  may  then  be  diluted 
with  water  to  any  desirable  extent. 

Therapcntic  Uses. — It  is  employed  in  fevers  as  an  antipyretic 
or  febrifuge  ;  also  for  the  same  purpose  in  acute  rheumatism, 
pneumonia,  phthisis,  diphtheria,  etc.  Externally  it  is  employed 
as  a  disinfectant  and  deodorizer,  many  preferring  it,  on  account 
of  its  freedom  from  odor,  to  carbolic  acid.  It  is  also  employed 
as  a  local  application  in  eczema  of  the  head  and  face,  syphilitic 
ulcers,  and  to  cancer,  gangrenous  and  sloughing  wounds,  in 
the  form  of  powder,  and  as  an  ointment  for  burns. 


208  DENTAL  MEDICINE. 


Salipyrine. — Prof.  Dr.  von  Hosengeil  (Bonn,  Germany) 
claims  that  the  action  of  antipyrine  in  such  cases  of  influenza 
which  show  no  rise  of  temperature  is  that  of  a  cardiac  poison. 
Salicyl  and  quinine  have  also  such  action.  By  combining 
salicylic  acid  and  antipyrine  he  claims  to  have  found  a  prepa- 
ration which  he  names  salipyrine,  which  has  proven  itself  to 
be  a  most  excellent  specific  anti-influenzic  remedy  in  just  such 
cases.     The  dose  he  employs  is  from  15  to  30  grains. 

Dose. — Of  salicylic  acid,  gr.  x  to  gr.  xx  or  xxx. 

Dental  Uses. — Salicylic  acid  is  employed  in  the  treatment 
of  suppurating  and  gangrenous  pulps  of  teeth,  in  the  form  of 
the  dry  powder  introduced  into  the  pulp  canals  and  permitted 
to  remain  for  several  days.  An  ethereal  solution  of  salicylic 
acid,  introduced  on  a  small  piece  of  punk,  has  also  been  em- 
ployed for  the  same  purpose,  where  it  is  difficult  to  introduce 
the  dry  powder ;  the  ether  volatilizes  in  a  few  minutes.  Sali- 
cylic acid  is  also  employed  with  advantage  in  inflamed  condi- 
tions of  the  mucous  membrane  of  the  mouth  and  gums,  and 
in  the  treatment  of  aphthae,  thrush  and  other  ulcers,  in  the 
form  of  a  solution.  For  such  purposes  its  combination  with 
powdered  cassia  or  cinnamon,  equal  parts,  is  recommended, 
to  be  applied  with  a  soft  brush.  Salicylic  acid  has  also  been 
found  efficacious  in  all  inflammatory  conditions  resulting 
from  decayed  and  dead  teeth  and  roots.  It  has  also  been  re- 
commended as  a  dentifrice,  in  the  form  of  an  alcoholic  solution 
of  the  acid  perfumed  with  oil  of  gaultheria ;  but  its  use  for 
such  a  purpose  is  questioned,  on  account  of  its  softening  effect 
upon  the  tooth  structure.  As  tannic  acid  interferes  with  the 
action  of  salicylic  acid,  these  agents  should  not  be  used  in 
combination. 

DENTAL   FORMULA. 

A  Disinfectant  Mouth    Wash.  A  Disinfecta^it  and  Stimulant  Mouth 

Wash. 
R .    Acidi  salicylici     .    .     i  part 

Sodii  phosphate    .    .     3  parts  U .    Acidi  salicylici     .    .    .    .5  ij 

Aquse  destillatse  .    .  30  parts.     M.  Spirit!  vini  rectificati  .   ^^x.        M. 

SiGNA. — Use  as  a  gargle.  SiGNA. — Use  as  a  gargle. 


SULPHURIC  ACID.  209 

For  Perspiration  of  Hands  and  Feet.       make  a  firm  ointment  that  will  adhere 

K .    Acidi  salicylici    .    .    3  parts  to  the  skin. 

Magnesii  silicat    ,    .  87  parts.     M. 

SiGNA. — Use  in  the  form  of  a  powder.  For  Burns. 

An  Emollient  and  Antiseptic   Garble.       „        «    -j-       i-     i-  • 

H .    Acidi  sahcylici    .    .    .  ^j 

R.    Acidi  salicyli    .    .    .    .  ^ij  Olei  OlivEe' gviij.    M. 

Sodiiboratis     .    .    .    .^iij  SiGNA.— Apply  as  a  lotion. 

Glycerini ^iiss 

Aquas  destillatse  .    .    .  ^iij.  M. 

SiGNA. — Add  I  or  2  drachms  to  half  a  For  Alveolar  Pyorrhea. 
pint  of  warm  water. 

For   Warts.  R-    ^"^"^i  saHcyHci    .    .    .  5J 

UiMNA.  Eucalyptol ^vi.       M. 

R .    Acidi  salicylici    .    .    .  3  iij  Signa.— Apply  to  pockets  by  means  ot 

Creasoti ^vj  cotton  or  a  broach. 

Cerje,  or  Adipis  .    .    .  aa    q.s.  to 

Antiseptic   Solution. 
Thiersch. 

R .        Acidi  salicylici 4  parts 

Acidi  borici 12  parts 

M.         Water 1000  parts,     M. 

Useful  for  a  wash  during  treatment  of  fractures  of  maxillae. 

ACIDUM   SULPHURICUM— SULPHURIC   ACID. 
OIL  OF  VITRIOL. 

Formula,  H2SO4.     Sp.  gr.,  1. 843. 

Derivation. — Sulphuric  Acid  is  obtained  by  burning  sulphur, 
mixed  with  one-eighth  of  its  weight  of  nitre,  over  a  stratum 
of  water  contained  in  a  chamber  lined  with  lead.  It  is  a  dense, 
colorless  liquid,  inodorous,  with  an  acrid  taste,  oily  consistence 
and  very  corrosive.  On  the  addition  of  water,  with  which  it 
unites  in  all  proportions,  there  is  an  evolution  of  heat.  In  the 
concentrated  form  it  is  only  used  externally  as  a  caustic. 
Being  an  acid,  corrosive  poison,  it  causes  death  from  asphyxia. 
The  antidote  is  magnesia  or  chalk,  or  solution  of  soap,  and 
mucilaginous  drinks  freely  administered. 

Medical  Properties  and  Action. — It  is  a  powerful  escharotic, 
and  when  applied  to  living  tissue,  the  parts  first  become  white, 
and  subsequently  a  browinsh-black  color.  It  is  not  used  in- 
ternally, on  account  of  its  corrosive  action.  It  is  considered 
14 


210  DENTAL  MEDICINE. 


to  be  one  of  the  most  effective  caustics  in  the  bites  of  rabid 
animals. 

Diluted  Sulphuric  Acid — Aciduni  SulpJmricum  Dilutum. 

Derivation. — It  is  prepared  by  diluting  sulphuric  acid  fsvij 
with  distilled  water  f^Ixxvij,  and  when  the  mixture  has  cooled 
to  60°,  add  more  water  olxxxiiiss.     Sp.  gr.,  1.094. 

Medical  Properties  and  Action. — It  is  refrigerant,  astringent 
and  tonic.  It  is  employed  as  a  refrigerant  in  fevers ;  as  an 
astringent  for  arresting  hemorrhage  and  passive-  mucous  dis- 
charges, and  as  a  tonic  to  improve  digestion.  As  it  is  very 
injurious  to  the  teeth,  the  proper  precautions  should  be  ob- 
served, as  in  the  case  of  all  acids  administered  as  medicines — 
such  as  alkaline  gargles  used  before  as  well  as  after  their  intro- 
duction in  the  mouth,  and  the  use  of  a  glass  tube  or  quill. 

Therapeutic  Uses. — Diluted  sulphuric  acid  is  employed  as  an 
internal  remedy  in  hemorrhage  from  the  lungs,  bowels  and 
uterus,  in  calculous  affections,  certain  skin  diseases,  diarrhoea, 
profuse  perspiration  of  phthisis,  in  the  advanced  stages  of 
typhus  and  typhoid  fevers,  scarlatina,  lead  poisoning,  etc. 
Externally  as  a  gargle  and  wash  to  ulcers. 

Dose. — Of  diluted  sulphuric  acid,  TTLv  to  lUxx,  three  times  a 
day,  in  water.' 

Aromatic  Sulphuric  Acid. — Aciduin  Sidphuricum  Aroniati- 
ciun — Elixir  of  Vitriol. 

Derivation. — Aromatic  sulphuric  acid  is  prepared  by  mixing 
sulphuric  acid  fSiij,  with  rectified  spirit  Oij,  and  adding  cin- 
namon oij,  and  ginger  oi/^-  It  is  a  reddish-brown  liquid, 
with  an  aromatic  odor  and  a  pleasant  taste. 

Medical  Properties  and  Action. — It  is  tonic  and  astringent, 
and  is  the  most  agreeable  form  of  sulphuric  acid  for  internal 
use. 

Therapeutic  Uses. — Aromatic  sulphuric  acid  is  employed  as 
a  substitute  for  the  diluted  form  in  debility  with  night  sweats, 
loss  of  appetite  during  convalescence  from  fevers,  haemoptysis 
and  other  hemorrhages,  and  epidemic  dysentery.  Externally 
it  is  applied  to  carious  bone,  ulcers,  in  the  treatment  of 
pyorrhoea  alveolaris,  especially  where  there  is  necrosis  of  the 


SULPHURIC  ACID.  211 


alveolar  walls,  when  it  is  applied  on  cotton  packed  in  the 
pockets ;  also  in  chronic  alveolar  abscesses.  For  such  pur- 
poses it  must  be  kept  in  the  pockets,  sinuses  and  abscesses  for 
several  hours  in  order  to  insure  its  full  effects.  It  is  also 
employed  locally  in  cancrum  oris  and  gangrene  of  the  mouth, 
and  largely  diluted,  it  forms  an  efficient  astringent  mouth- 
wash in  simple  stomatitis,  etc. 

Dose. — Of  aromatic  sulphuric  acid,  TTLv  to  TTLxxx,  three 
times  a  day,  in  water. 

Dental  Uses  of  the  Different  Forms  of  SulpJutric  Acid. — The 
concentrated  sulphuric  acid  is  employed  as  a  caustic  in  malig- 
nant ulcers,  cancrum  oris,  gangrene,  etc.,  in  the  form  of  a 
paste,  made  by  mixing  it  with  powdered  sulphate  of  zinc.  The 
concentrated  sulphuric  acid  is  also  used  in  the  dental  labora- 
tory to  cleanse  metal  plates,  preparatory  to  and  after  solder- 
ing, for  which  purpose  it  is  generally  diluted  with  one-third  of 
water,  its  action  being  greater  when  it  is  in  a  warm  state.  The 
concentrated  acid  is  also  used  in  combination  with  nitric  acid 
to  reduce  hemp  paper  to  pyroxylin,  in  the  preparation  of  the 
celluloid  base. 

The  aromatic  sulphuric  acid  is  similar  in  its  action  to  the 
diluted  form,  and  is  more  agreeable  for  use  about  the  mouth. 

It  is  a  valuable  application  in  pyorrhoea  alveolaris  (Riggs' 
disease),  and  in  caries  and  necrosis  of  the  maxillary  bones,  as 
an  injection  or  lotion,  as  it  stimulates  the  parts  to  healthy 
action  by  favoring  granulation.  It  may  be  applied  to  parts 
about  the  teeth,  in  cases  of  recession  of  the  gums  and  absorp- 
tion of  the  processes,  on  a  properly-shaped  piece  of  orange 
wood.  It  is  also  valuable  in  alveolar  abscesses  as  an  injection, 
especially  in  sluggish  cases,  when  the  addition  of  a  few  drops 
of  tincture  of  capsicum  will  prove  serviceable.  It  has  the 
power  of  dissolving  the  thin,  carious  portions  of  the  bones, 
such  as  the  margins  of  the  alveolar  cavities,  and  can  be  applied 
on  cotton  saturated  with  it  and  permitted  to  remain  for  several 
hours,  when  the  parts  should  be  perfectly  cleansed  with  warm 
water.  It  is  also  employed  as  a  gargle,  properly  diluted,  in 
mercurial  inflammation  of  the  mouth  and  other  forms  of  sto- 


212  '       DENTAL   MEDICINE. 


matitis,  which  do  not  yield  to  the  influence  of  milder  astrin- 
gent washes.  It  is  also  employed  in  the  treatment  of  aphthae 
and  other  ulcers  of  the  mouth. 

Dr.  W.  H.  Atkinson  speaks  very  favorably  of  the  action  of 
aromatic  sulphuric  acid  upon  morbid  growths  and  ulcerating 
surfaces,  especially  in  pockets  where  the  connective  tissue  has 
been  destroyed  and  deep  chasms  exist  along  the  line  of  teeth, 
between  the  cementum  and  alveolar  walls.  After  drying  out 
such  pockets  with  bibulous  paper,  drops  of  sulphuric  acid,  in 
full  strength,  should  be  dropped  into  the  open  mouth  of  the 
pocket  until  it  stands  full,  on  a  level  with  the  surface  of  the 
gum  and  teeth.  This  is  repeated  when  the  contents  of  the 
pocket  is  absorbed,  again  and  again ;  after  which  the  mouth 
is  washed  with  a  saturated  solution  of  bicarbonate  of  soda  in 
distilled  water.  After  drying  the  pocket  with  bibulous  paper, 
a  paste  of  tannin  and  glycerine,  smoothly  spread  upon  several 
folds  of  the  same  paper,  is  laid  over  the  surface,  and  the  patient 
directed  to  use  hydronaphthol  solution  as  a  mouth-wash,  fre- 
quently during  the  day.  The  following  day,  the  pocket  is 
washed  out  with  peroxide  of  hydrogen,  fifteen  volume 
medicinal,  until  it  ceases  to  bubble ;  then  repeat  the  appli- 
cation of  the  aromatic  sulphuric  acid  in  the  same  manner 
as  first  described.  The  hydronaphthol  solution  should  be 
used  frequently,  and  also  a  bichloride  of  mercury  solution, 
three  or  four  times  a  day,  until  there  is  no  longer  any  evidence 
of  pus  when  the  peroxide  is  injected.  Dr.  J.  R.  Callahan 
recommends  a  20  to  50  per  cent,  aqueous  solution  of  sulphuric 
acid  for  opening  the  canals  of  teeth  where  the  roots  are  curved 
or  the  canals  obstructed  by  osseous  growths. 

DENTAL   FORMULA. 

For  Mercurial  and    Ulcerative  Sto-         For  Aphtkce  attd  Other  Ulcers  of  Mu- 
matitis.  ecus  Membrane  and  Gums. 

Thomas.                               jj.    Acidi  sulphurici  .    .    .  fgss 
R.    Acidi  sulphurici  .    .    .  TTLx  ,    Mellis f^j.        M. 

Decocti  hordei    .    .    .  f5iv  Signa. — To  be  applied  with  a  camel- 

Mellis f^ss.  M.  hairbrush. 

Signa. — Use  as  a  gargle. 


SULPHUROUS   ACID.  213 


For  Alveolar  Pyorrhoia.  For  Diarrhcea  During  Dentition. 

Dr    a    W.  Harlan  ^^  '^^  stools  are  serous  and  alkaline. 

R.       Acidi  sulphurici  .    .  TTt^xx  Dr.  James  W.  White. 

Essence  cinnamon,    .   ^ss  R.    Acidi  sulph.  aromat.  gtt.viij 

Aquse ^ss.       M.  Spt.  vini  gallici    .    .  fjij 

SiGNA. — Inject  with  a  syringe   i  or  2  Syr.  acacise  .... 

minims   in    each  pocket  if  they  are  Aquas  menth.  pip.   .  aaf^ss.    M. 

deep  and  sinuous,  or  carious;  repeat  SiGNA. — A   teaspoonful  every  2  hours 

every  fourth  day.  in  a  little  water.  ' 

For  Carious  Bone,  -Riggs^  Disease,  etc. 

R .        Acidi  sulphurici  aromat f  3  iii 

Tinctura  capsici gtt.x 

Aquae f.^"-  M. 

SiGNA. — To  be  used  as  an  injection  or  lotion. 

ACIDUM   SULPHUROSUM— SULPHUROUS   ACID. 

Formula. — H2SO3. 

Derivation. — Sulphurous  Acid  is  made  by  dissolving  sul- 
phurous   anhydride   (SO2)  in  water.     The  latter  is  made  by 
burning  sulphur.     It  is  a  colorless  liquid,  having  the  suffo- . 
eating  odor  of  burning  sulphur,  and  a  sour,  astringent  taste. 

Medical  Properties  and  Action. — It  is  a  deodorizer  and  dis- 
infectant, and  destructive  to  micro-organisms,  such  as  bacteria, 
fungi,  etc. 

Owing  to  its  affinity  for  oxygen  it  acts  upon  organic  matter 
with  great  energy. 

TJicrapentic  Uses. — The  diluted  acid  is  locally  applied  to 
ulcers  of  the  tonsils  in  diphtheria,  syphilitic  and  tuberculous 
laryngitis,  chilblains,  parasitic  skin  diseases,  ill-conditioned, 
sloughing  or  gangrenous  wounds ;  also  used  in  pyrosis,  indi- 
gestion, etc. 

Also,  in  the  form  of  inhalations  of  the  sulphurous-acid  gas, 
in  cases  of  chronic  bronchitis,  etc.  In  the  form  of  spray,  it 
is  used  as  a  local  application  in  diseases  of  air  passages. 

Dose. — Of  sulphurous  acid,  ITLv  to  5j. 

Dental  Uses. — Dilute  sulphurous  acid  is  efficacious  in  mer- 
curial stomatitis,  aphthse,  and  mucous  patches,  gangrene  of 
the  mouth,  cancrum  oris,  ulcers  of  mucous  membrane,  and 


214  DENTAL   MEDICINE. 


sloughing  wounds.     It  is  an  efficient  and  convenient  disin- 
fectant. 

For  Chilblains.  For  Destroying  Parasites  in  Skin  Diseases. 

Bartholow.  Startin. 

R.    Acidi  sulphurosi  .    .    .  ^iij  R.    Acidi  sulphurosi,  dil.  .  gss 

Elycecint gj  Sodii  hyposulphitis  .    .   "^u] 

Aquae ^iss.  M.                 Aquae,  q.  s.  ad.    .    .    .  |xvj.     M, 

SiGNA. — Apply  as  a  lotion.  SiGNA.— Apply  as  a  lotion. 

ACIDUM   TANNICUM— TANNIC  ACID. 
TANNIN. 

Formula.— Cuy^,,0^^{C,U^\  (OH)^©,  CO,  CO,  OH. 

Derivation. — Tannic  Acid  is  obtained  by  exposing  powdered 
galls  to  a  damp  atmosphere  for  several  days,  when  sufficient 
ether  is  added  to  form  a  soft  paste,  which  is  allowed  to  stand 
for  twenty-four  hours.  It  is  then  subjected  to  pressure  as 
quickly  as  possible,  and  the  mass  again  treated  with  ether,  to 
which  -^  of  its  bulk  of  water  has  been  added  ;  this  is  allowed 
to  stand  as  before,  and  is  again  subjected  to  pressure;  The 
expressed  liquids  are  now  combined  and  allowed  to  evaporate 
spontaneously ;  then,  by  the  aid  of  a  little  heat,  brought  to  a 
syrupy  consistence,  when  it  is  dried  on  plates  in  a  hot  air 
chamber,  at  a  temperature  not  exceeding  212°  F,  Pure  tannic 
acid  is  solid,  uncrystallizable,  either  white  or  slightly  yellow- 
ish, inodorous,  astringent  to  the  taste,  but  without  bitterness, 
and  with  an  acid  reaction.  It  is  obtained  in  the  form  of  vesic- 
ular masses,  or  thin,  glistening  scales,  or  in  the  shape  of  fine 
threads  of  a  pseudo-crystalline  appearance.  Tannic  acid 
exists  also  in  rhatany,  catechu,  and  other  vegetable  astrin- 
gents, as  it  is  their  chief  principle. 

Medical  Properties  and  Action. — Tannic  Acid  is  considered 
to  be  the  most  active  of  all  vegetable  astringents  and  styptics, 
and  especially  powerful  on  albumen,  gelatin  and  fibrin.  It  is 
very  soluble  in  water,  and  less  so  in  alcohol  and  ether.  Taken 
internally,  it  produces  no  nausea,  is  perfectly  safe,  and  its  use 
may  be  continued  for  a  long  time  without  any  ill  effects.  It 
may  also  be  administered  before  and  after  meals,  at  all  times, 


TANNIC  ACID.  215 


and  be  combined  with  many  other  remedies,  such  as  iron, 
cod-Hver  oil,  bitters,  etc.  Like  gallic  acid,  it  is  capable  of 
taking  oxygen  even  from  the  blood  globules,  when  in  contact 
with  alkalies. 

Tannic  acid  is  converted  into  gallic  acid  in  the  blood,  by 
absorbing  oxygen  from  the  red  corpuscles ;  this  absorption 
does  not  occur  in  the  stomach. 

Tannic  acid  unites  with  albumen,  fibrin  and  gelatin,  forming 
insoluble  tannates,  thus  preserving  the  parts  beneath  from  the 
influence  of  irritating  agents  until  resolution  occurs. 

Its  solution  reddens  litmus  paper,  and  it  is  decomp9sed  and 
entirely  dissipated  when  thrown  upon  red-hot  iron. 

Listerine  is  one  of  the  best  solvents  for  tannic  acid.  One 
ounce  of  listerine  will  dissolve  half  an  ounce  of  tannic  acid. 

Therapeutic  Uses. — Internally  it  is  administered  in  hemor- 
rhages of  the  lungs,  stomach,  kidneys  or  uterus,  chronic 
bronchial  catarrh,  phthisis,  after  softening  has  taken  place, 
intermittent  fever,  whooping  cough,  chronic  diarrhoea,  diseases 
of  the  genito-urinary  organs,  dyspepsia,  diphtheria,  nervous 
diseases,  etc.  Externally  it  is  applied  to  hemorrhages  and 
profuse  secretions,  mercurial  salivation,  diseases  of  the  eye, 
nasal  polypus,  gonorrhoea  and  gleet,  bed  sores,  relaxation  of 
uvula,  skin  diseases,  ulcers,  etc. 

Dose. — Of  tannic  acid,  gr.  j  to  Bj,  in  pill. 

Dental  Uses. — In  dental  practice  tannic  acid  is  a  valuable 
agent  for  local  use  in  the  treatment  of  such  diseases  as  mer- 
curial stomatitis,  ulceration  of  the  gums  and  mucous  mem- 
brane of  the  mouth,  hypertrophy  of  the  gums,  hemorrhage 
following  the  extraction  of  teeth  and  wounds  of  mucous  mem- 
brane, fungous  growth  of  pulp,  sensitive  dentine,  sponginess 
of  the  gums,  for  the  temporary  relief  of  odontalgia,  disease  of 
the  antrum.  In  mercurial  salivation  tannic  acid,  in  the  form 
of  powder,  moistened  with  water,  will  render  the  spongy  gums 
firmer  and  more  comfortable,  causing  contraction  of  the  ves- 
sels and  checking  a  tendency  to  absorption  and  the  consequent 
loosening  of  the  teeth.  A  strong  solution  of  tannin  in  alcohol 
is  beneficial  in  obtunding  the  sensitiveness  of  dentine,  or  the 


216  DENTAL  MEDICINE. 


tannin  may  be,  in  the  form  of  a  powder,  combined  with  mor- 
phine and  creasote.  Tannic  acid,  in  the  form  of  a  paste  or 
ointment,  made  by  rubbing  two  scruples  of  tannin  with  twenty 
drops  of  glycerine,  and  then  with  an  ounce  of  lard,  makes  a 
good  astringent  application.  A  gargle  composed  of  tannic 
acid  and  glycerine  is  -a  useful  application  for  abrasions  caused 
by  artificial  teeth  and  other  irritants.  A  preparation  known  as 
Elixir  of  Vitriol  and  Tannin,  saturated  solution,  is  a  pov/erful 
astringent  and  haemostatic  when  applied  to  bleeding  surfaces^ 
fungous  growths,  etc. 

An  English  preparation  known  as  Styptic  Colloid,  is  a  satu- 
rated solution  of  tannin  and  gun  cotton,  and  is  highly  recom- 
mended for  its  styptic  and  deodorizing  properties,  as  it  solidifies 
blood  and  albumen  by  mere  contact,  and  can  be  applied  directly 
by  means  of  a  camel-hair  brush,  or,  mixed  with  an  equal 
quantity  of  ether,  in  the  form  of  spray.  No  irritation  follows 
its  use,  and  for  hemorrhage  from  the  extraction  of  teeth,  or, 
in  the  treatment  of  necrosed  or  carious  maxillary  bones,  it  is 
very  efficient.  Cold  or  warm  water  will  not  dissolve  it ;  but 
an  ether  and  alcohol  solution  may  be  used  to  remove  the 
dressing. 

Tannic  acid,  as  an  internal  remedy,  has  also  been  success- 
fully administered  for  checking  hemorrhage  after  tooth-ex- 
traction. Dr.  W.  L.  Roberts  says  :  Tannic  acid,  administered 
internally  in  proper  doses,  will  stop,  I  believe,  any  case  of 
such  hemorrhage,  in  from  thirty  minutes  to  one  and  one-half 
hours'  time.  He  recommends  three  grains  of  tannic  acid  in 
one-third  glass  of  water,  giving  as  a  dose  two  teaspoonfuls  of 
the  solution  every  five  minutes  until  three  doses  are  taken  ; 
then  two  teaspoonfuls  every  fifteen  minutes  if  required.  Dr. 
Roberts  further  says,  that  such  treatment  has  never  failed  him. 

A  styptic  and  antiseptic  cotton  can  be  prepared  by  saturat- 
ing purified  cotton  with  tannic  acid,  5  parts ;  carbolic  acid,  4 
parts ;  alcohol,  50  parts.  The  cotton  should  be  dried  and 
preserved  air-tight. 

Glycerite  of  tannic  acid — Glyceritiun  Acidi  Tannici,  for  ex- 
ternal use,  is  made  of  tannin,  Sij;  glycerine,  oviij. 


TANNIC  ACID. 


217 


Ointment    of   tannic    acid- 
made  of  tannin,  5j ;  lard,  oj. 
ulcers. 

DENTAL 

For  an  Astringent  Dentifrice. 

R  .    Acidi  tannici     ....  gr.xxx 
Cretse  preparatse  .    .    .   ^  ij 
Pulveris  ossis  sepice    .  ^  ij 
Olei  caryophylli  .  gtt.iij.     M. 

For  Inflamed  Mucous  Membrane,  Abra- 
sions, Ulcers  and  Sensitive  Dentine. 

R.  Acidi  tannici  .  .  .  .  ^ij 
Tincturae  arnicse  .  .  .  ^ij 
Tincturae  myrrhae    .    .   ^j-         M. 

SiGNA. — To  be  used  as  a  lotion. 

For  savie  as  above. 
R.    Acidi  tannici    .    .    .    •  3J  to  ^ij 
Spiriti  rectificati   .    .    .  ^j 
Aquse  destillatse  .    .    .   g  x.        M. 
SiGNA. — To  be  used  as  a  gargle. 

For    Inflamed  and    Ulcerated  Mucous 
Membrane. 

R .  Acidi  tannici  .  .  .  .  5  ss 
Spiriti  vini  rectificati  .  ^ss 
Aquse  camphorse  .    .    .  f^v.       M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Inflamed  and  Ulcerated  Gzuns. 
R .    Acidi  tannici    .    .    .    .   3;  iv 

Glycerini      ^ij.        M. 

SiGNA. — To  be  used  as  a  gargle  or 
mouth -wash. 

For  same  as  above. 
R.    Acidi  tannici    .    .    .    .   ^ij 
Tinct.  iodinii   .    .    .    .   J^iv 
Potassii  iodidi  ....  gr.xx 
Tinct.    myrrhfe     .    .    .  ^iv 

Aqu£e  rosre fgviij.    M. 

SiGNA. — A  dessert-spoonful  in  a  wine- 
glass of  water  as  a  mouth-wash  or 
girgle. 


—  Ungnentuni  Acidi    Tannici,    is 
Useful  for  a  local  application  to 


FORMULA. 

For  Infia?7ied  Mucous  Membrane  of 
Mouth. 
R.    Acidi  tannici    .    .    .    .  ^ij 
Pulveris  aluminis     .    .  gr.xxx 
Aquse  destillatse  .    .    ,   ^  v.        M. 
SiGNA. — To  be  used  as  a  gargle. 

For   Sensitiveness    following    the    Re- 
moval of  Salivary   Calculus.        ' 

Coleman. 
R.    Acidi  tannici    .    .    .    .  ^ss 

Eau  de  Cologne  .    .    .  f^iv.     M. 

Signa. — Add   10  or  12  gtts.  of  above 

solution    to    a   teaspoonful    of    tepid 

water,  and  use  as   a  gargle  3  or  4_ 

times  a  day. 

For  Loose    Teeth    and  Spongy    Gums. 


R .    Acidi  tannici    .    . 

•    •   3Jss 

Potassii  iodidi  .    . 

.    .    gr.xii 

Tinct.  iodi    .    .    . 

•    •    ^j 

Tinct.  myrrhag  .    . 

•    •    5J 

Aquse  rosse  .    .    . 

.    .   5vi. 

M 

Dissolve  the  tannic  acid  and  iodide 

of  potassium  in  the  rose 

water  and  add 

the  tinctures  and  strain. 

Signa. — A  teaspoonful 

in  a  wine- 

glass 

of  warm  water,  used 

every  morning 

as  a  mouth  wash. 

For  an  Astringettt  Mouth-  Wash  in  In- 
flamed and  Ulcerated  Conditions  of 
Gum  and  Mucous  Membrane. 

R  .    Acidi  tannici    ....    gr.x  to  xv 
Tincturse  pyrethri   .    .   ^iij 
Aquse  rosje ^vj.       M. 

Signa. — To  be  used  as  a  gargle. 
For   Ulcerations  and  Abrasions. 

R.    Acidi  tannici    .    .    .    .  gr.xv 

Glycerini ^oi-        ■^^• 

Signa. — To  be  used  as  a  lotion. 


218 


DENTAL  MEDICINE. 


For    Inflamed  Mucous    Membrane    of 
Mouth. 

R .    Acidi  tannici    .    .    .    .  ^  ss 

Sodii  boratis    .    .    .    •  ^iij 

Glycerini ^ij 

Aquas  destillatse  .    .    .  §  iv.       M. 

SiGNA. — Use  as  a  gargle. 

For  Inflamed  Mucous   Membrane   of 
Mouth  and  Fauces. 

R.    Acidi  tannici    .    .    .    .  ^j 

Tinctura  myrrhae    .    .  giij 

Pulv.  acacise    .    .    .    .  ,^ij 

Glycerini ^ij 

Aq.  destil.  q.s.ad.    .    .  §vj.       M. 

SiGNA. — Use  as  a  gargle. 

For  Odontalgia. 
Druitt. 
R .    Acidi  tannici    ....  gr.xx 
Gun  mastich    ....  gr.x 
Spt.  Eether  sulph  .    .    .f|ss.     M. 
SiGNA. — To    be    applied     to    carious 
cavity,  on  a  pellet  of  cotton. 


For  Alveolar  Hemorrhage. 

R .    Acidi  tannici    ....  gr.xl 
Liq.    plumb,    subacet. 

dilut f^iss 

Vin.  opii  .   ' f^ss.     M. 

SiGNA. — Apply  on  cotton  or  lint,  or  as 
an  injection. 

For  Chronic  Ulcers  and  Abscesses. 
Berel. 
R.    Acidi  tannici    .    .    .    .  gr.xxxij 

Aquae  destillatse   .    .    .  fgviij.  M. 
SiGNA. — To  be  used  as  a  lotion. 

Astringent  and  Antiseptic  Gargle. 

R .    Tannin 5  grammes. 

Tincture  iodine  .    . 
Tincture  myrrh  .  aa  2  ^^  grammes. 
Iodide  of  potassium      i  gramme. 
Rose  water.    .    .    .  180  grammes  • 
M. 

SiGNA. — A    teaspoonful   in  a  glass   of 
water. 


acidum  tartaricum— tartaric  acid. 

Formula. — H2C4H4O6.  ' 

Derivation. — Tartaric  Acid  is  obtained  from  "tartar"  (a 
peculiar  substance  which  concentrates  on  the  inside  of  wine 
casks,  being  deposited  during  the  process  of  fermentation),  or 
from  crude  cream  of  tartar. 

It  is  in  the  form  of  white  or  colorless  crystals,  irregular, 
six-sided  prisms,  and  is  soluble  in  water  and  alcohol,  and 
wholly  dissipated  by  heat. 

Medical  Properties  a7id  Action. — It  is  refrigerant,  and  dis- 
solved in  water  and  sweetened,  is  a  good  substitute  for  lem- 
onade. 

In  large  doses  it  is  an  irritant  poison,  and  when  its  internal 
use  is  followed  by  a  red  and  dry  tongue,  it  should  be  discon- 
tinued. It  is  often  administered  in  the  form  of  effervescing 
powders. 

Therapeutic  Uses. — Internally  it  is  employed  as  a  refrigerant 


ACONITE.  219 

in  inflammatory  and  febrile  diseases,  irritability  of  the  stomach, 
nausea  and  vomiting,  dyspepsia,  and  diseases  attended  with 
copious  secretion  of  mucus,  dysentery,  etc.,  etc. 

Dose. — Of  tartaric  acid,  gr.  x  to  gr.  xx,  dissolved  in  water 
and  sweetened. 

Dental  Uses. — In  combination  with  an  equal  quantity  of 
chloride  of  lime,  it  is  employed  for  bleaching  discolored  teeth. 

ACONITUM— ACONITE. 
WOLFSBANE,  MONKSHOOD. 

Source. — Aconite  is  obtained  from  the  dried,  tuberous  root 
of  Aconituin  Napelhts,  a  perennial  plant  abounding  in  the 
mountains  of  Europe  and  Asia.  The  leaves  and  root  are  both 
used,  but  the  latter  is  the  most  powerful.  The  alkaloid 
Aconitia  or  Aconitine,  a  sedative  poison,  is  obtained  from  the 
root,  and  is  externally  employed  for  neuralgic  affections,  pro- 
ducing a  sensation  of  heat  and  pricking,  succeeded  by  a  feel- 
ing of  numbness  and  constriction  in  the  part  on  which  it  is 
rubbed ;  and  very  satisfactory  results  have  been  obtained 
from  the  internal  administration  of  Duquesnel's  Aconitia,  in 
neuralgia  of  the  fifth  pair  of  nerves.  Another  principle  of 
aconite,  suggested  by  Duquesnel,  is  known  as  Napelline, 
which  is  less  powerful  than  aconitia,  but  possesses  important 
hypnotic  properties,  and  is  substituted  for  opium  and  chloral, 
especially  in  cases  of  wakefulness  and  mental  excitement  dur- 
ing neuralgic  attacks. 

Medical  Properties  and  Action. — Aconite  is  a  powerful  seda- 
tive to  the  nervous  system,  and  reduces  the  force  of  the  circu- 
lation. In  large  doses  it  is  an  active  poison,  lessening  the 
heart's  action,  affecting  its  ganglia  and  muscle,  and  paralyzing 
the  muscles  of  respiration.  In  moderate  doses  it  produces 
warmth  in  the  stomach,  general  warmth  of  the  body,  and 
sometimes  nausea,  numbness  and  tingling  in  the  limbs  and 
fingers,  muscular  weakness,  diminished  force  and  frequency 
of  the  pulse  and  diminished  respiration.  It  proves  fatal,  in 
poisonous  doses,  by  its  powerfully  sedative  impression  on  the 
nervous  system,  by  suspension  of  the  respiratory  function  and 
by  syncope. 


220  DENTAL   MEDICINE. 


Therapeutic  Uses. — Aconite,  in  the  form  of  an  extract  pre- 
pared from  the  leaves,  and  a  tincture  prepared  from  the  root, 
is  administered  in  all  inflammatory  and  febrile  affections,  acute 
rheumatism,  neuralgia,  especially  in  chronic  cases  of  neuralgia, 
where  all  the  signs  of  active  disease  are  absent,  or  have  been 
relieved  by  other  remedies ;  tetanus,  sciatica,  diseases  of  the 
heart,  erysipelas,  ar«enorrhoea,  tonsillitis,  acute  congestion  of 
liver,  peritonitis,  eruptive  fevers,  etc.,  etc.  It  is  contraindi- 
cated  in  inflammatory  conditions  of  the  gastro-intestinal  mu- 
cous membrane.  It  is  locally  applied  to  painful  sprains  and 
bruises,  and  chronic  arthritic  swellings. 

Dose. — Of  the  tincture  of  aconite — tinctura  aconiti — gtt.  j  to 
gtt.  v ;  of  the  extract  of  aconite — extrachun  aconiti — gr.  j  to 
gr.  ij.  The  tincture,  of  the  root  is  composed  of  twelve  troy- 
ounces  to  alcohol  Oij.     Dose  of  aconitia,  gr,  -<^\-^. 

Dental  Uses. — Aconite,  in  the  form  of  the  tincture,  is  a  val- 
uable agent  in  dental  practice.  When  locally  applied,  it  checks 
inflammation  in  its  early  stages,  by  paralyzing  the  nerves  of 
the  part  and  lessening  the  excitement  to  the  local  afflux  of 
blood,  favoring  resolution  and  limiting  the  extent  of  an  abscess 
where  pus  is  already  formed.  Combined  with  an  equal  part 
of  the  tincture  of  iodine,  it  is  a  valuable  application  in  the 
incipient  stages  of  periodontitis,  as  it  relieves  the  inflammation 
by  retarding  the  circulation  and  stimulating  lymphatic  action. 
For  such  purpose  the  gum  or  root  of  the  affected  tooth  should 
be  painted  with  this  combination  until  it  assumes  a  dark  brown 
color,  taking  the  precaution  to  first  remove  all  moisture  from 
the  surface  to  which  it  is  to  be  applied,  and,  after  its  applica- 
tion, protecting  the  adjoining  parts,  such  as  the  lips  or  cheeks, 
until  the  remedy  is  absorbed.  A  drop  or  two  of  the  tincture, 
introduced  into  ,the  cavity  of  an  aching  tooth,  will  relieve 
odontalgia;  and  the  same  quantity  will  subdue  the  pain 
which  follows  the  extraction  of  a  tooth,  especially  when  the 
cause  has  been  the  inflammation  of  the  peridental  membrane. 
Tincture  of  aconite  is  also  serviceable  in  the  conservative 
treatment  of  irritated  or  inflamed  pulps  of  teeth.  Combined 
with  an  equal  quantity  of  chloroform,  it  is  applied  as  a  local 


ACONITE. 


221 


anaesthetic  for  the  extraction  of  teeth.  For  the  same  purpose 
it  is  combined  with  chloral,  pyrethrum,  morphia,  etc.  (See 
Dental  Formulae.)  It  is  also  a  useful  dressing  for  the  pulp 
canals  of  teeth,  preventing  the  formation  of  inflammatory  pro- 
ducts. The  alkaloid,  aconitia,  is  a  useful  remedy  in  neuralgia 
of  the  fifth  pair  of  rierves.  (See  Dental  Formulae.)  Care  is 
necessary  in  the  application  of  the  tincture  of  aconite  to  large 
surfaces,  or  where  the  skin  is  abraded,  as  dangerous  constitu- 
tional effects  may  result.  Fifteen  drops  of  the  tincture,  taken 
internally,  have  caused  death.  The  symptoms  of  poisoning  by 
aconite  are  as  follows :  Overpowering  sense  of  fatigue  in  the 
lower  extremities,  great  muscular  weakness,  dimness  of  vision, 
with  dilated  pupils ;  great  dyspncea,  the  respiration  being 
short  and  labored ;  the  pulse  at  first  slow  and  small,  and 
afterward  imperceptible  ;  surface  of  body,  tongue  and  breath 
cold ;  a  profuse  perspiration  ;  muscles  of  respiration  paralyzed  ; 
ceasing  of  the  heart's  action.  The  antidotes  are  emetics  and 
stimulants — heat,  brandy  and  ammonia ;  keep  flat  on  back. 


DENTAL   FORMULA 
For  Neuralgia. 
R  .    Pulveris  radicis  aconti  ^  x 


Camphorae 3  ss 

Spiriti  rectificati  .    .    .  q.s. 

Moisten  the  aconite  with  some  of  the 
alcohol  and  macerate  in  a  close  vessel 
for  3  days,  then  percolate  slowly  into  a 
receiver  containing  the  camphor  until 
product  measures  half  a  pint. 
SiGNA.— Apply  with  a  camel-hairbrush. 

For   Odontalgia. 

K .    Tincturae  aconiti, 

Chloroformi —  .    .    .    .  aa  f  5  iij 
Tinct.  capsici  .    .    .    .  fgj 
Tinct.  pyrethri., 
01.  caryophylli    .    .    .  aa  f^ss 
Gum  camph 5  ss.       M. 

SiGNA. — -To  be  applied   on  a  pallet  of 
cotton. 


A  Local  An(Esthetic  for  the  Extraction 
of  Teeth. 

R .    Tincturas  aconiti  .    .    .  3  i^^s 

Pyrethri jiij 

Veratrinse gr.x 

Morphinse  sulphas  .  .  gr.iv 
Spiriti  rectificati  .  .  .  ^  iv 
Chloral  hydratis  .    .    .  gr.iv.      M. 

Let  it  stand  4  days  and  then  filter. 
SiGNA. — Apply  to  the  gum  over  root  of 

tooth  to  be  removed  for  60  seconds, 

by  means  of  an  applicator. 

For  a  Local  Ancesthetic  for  Extraction 
of  Teeth. 

R.    Tinctura  aconiti  .    .    .  f^j 

Menthol gr.x 

Chloroformi      .    ,    .    .  f^j.         M. 
SiGNA. — Apply    freely    to    gum    about 
tooth  for  several  minutes. 


222 


DENTAL   MEDICINE. 


For  Neuralgia  and  Rheumatic  Pains, 
Bruises,  etc. 

Glycerini, 

Alcohol    ^^3] 

R .    Tincturae  aconiti, 
Chloroformi  venalis, 
Spirit!  ammonias  .    . 

.  aa 

f.^ij 

Aquae  menthas  pip.  .    .  ^ij.        M. 
Dose. — A  teaspoonful,  slowly  and  cau- 
tiously increased  to  ^. 

Oleo  ricini    .... 
Liiiimenti  saponis    . 

•  3 

i 

M. 

For  Periodontitis. 

SiGNA. — To  be  rubbed  on  the  affected 
part. 

For  Neuralgia  of  Fifth  Pair  of  Nerves. 
(For  Internal  Use.) 

H .    Aconitse gf'-A 

Glycerini, 

Alcohol ^2-  3J 

Aquae  menthse  pip   .    .    .    .  gij.        M. 
Dose. — A  teaspoonful. 

For  Neuralgia. 
R.    Linimenti  aconiti, 

Lin.  belladonnae  .    .    .  aa  ^vij 
Chloroformi      .    .    .    .  ^ij.        M. 
SiGNA. — Apply  on  lint,  to  the  part  af- 
fected, and  cover  with  a  fine  piece  of 
sponge  saturated  with  warm  water. 

For   Trigeminal  Neuralgia. 

R.    Aconitinae  (Duques- 

nel's) gr.J^ 


R.    Tincturae  iodi, 

Tincturae  aconiti  .    .    .  aa  ^  ss.  M. 
SiGNA. — Apply  to  gum  over  root  of  af- 
fected tooth  with  a  camel-hair  brush. 

To  Abo7't  an  Abscess. 

Dr.  Geo.  Watt. 

R .    Ext.  aconiti,  fl. 

Ext.  belladonnae,  fl. 
Ext.  opii.,  fl  .  aa  equal  parts.    M. 
SiGNA. — Apply  with   brush  as  needed 
to  ease  pain ;  also  give  fluid  extract 
of  phytolaccae  internally. 

For  Odontalgia^  Internal    Treatment. 

Dr.  Dunogier. 
R .    Aconitine  (crystallized)  ^  milligr. 

Gelsemine i  milligr. 

Valerianate  of  quinine  .    5  centigr. 
For  one  pill. 
M.  S. — One  to  three  pills  to  an  adult 
in  the  24  hours. 


^THER— ETHER. 

^THER   SULPHURICUS— SULPHURIC   ETHER. 

Formula. — C4H10O,  or  (021^5)20.  Sp.  gr. — Of  pure  ether, 
0.713;  of  .stronger  ether,  0.728;  of  ordinary  officinal  ether, 
0.750. 

Derivation. — Sulphuric  Ether  is  obtained  by  the  distillation 
of  alcohol  and  sulphuric  acid,  and  is  rectified  by  re-distillation 
with  solution  of  potassa.  The  form  of  sulphuric  ether  em- 
ployed for  inhalation  is  still  further  purified  by  agitation  with 
water,  and  it  is  freed  from  this  and  from  an  excess  of  alcohol 
and  deleterious  acid  substances  by  the  action  of  chloride  of 
lime  and  freshly  calcined  lime,  when  it  is  known  as  stronger 


ETHER.  223 

ether — ^ther  Fortior.  Sp.  gr.,  0.728.  Sulphuric  ether  is  a 
colorless,  limpid,  volatile  and  inflammable  fluid,  with  a  sweet 
odor  and  a  hot,  pungent  taste;  on  account  of  its  great  vola- 
tility, it  should  be  kept  securely  in  ground-glass-stoppered 
bottles.  It  usually  reddens  litmus  paper  slightly;  when  it 
does  so  strongly,  the  ether  is  impure.  The  impurities,  besides 
acids  and  fixed  substances,  are  heavy  oil  of  wine,  an  excess  of 
alcohol  and  water.  Acids  being  detected  by  litmus  paper, 
may  be  removed  by  agitation  with  potassa ;  fixed  substances 
may  be  removed  by  evaporating  the  ether.  Some  alcohol  is 
always  found  in  ether,  and  it  is  only  when  it  is  present  in  too 
great  a  quantity  that  the  density  of  the  ether  is  rendered  too 
high.  The  quantity  of  alcohol  any  preparation  of  ether  may 
contain,  can  be  determined  by  agitating  it  in  a  minim  measure 
with  half  its  volume  of  a  concentrated  solution  of  chloride  of 
calcium.  This  will  remove  the  alcohol,  and  the  reduction  of 
the  volume  of  ether  when  it  rises  to  the  surface  will  indicate 
the  amount  of  alcohol  which  has  been  present.  Heavy  oil  of 
wine  can  be  detected  by  the  ether  becoming  milky  when 
mixed  with  water.  Ether  boils  at  98°  F.,  and  a  cold  of  166° 
below  zero  will  not  freeze  it.  When  kept  too  long  it  under- 
goes decomposition,  and  is  converted  in  part  into  acetic  acid. 

It  evaporates  so  readily  and  completely  in  the  air  as  to  cause 
a  great  degree  of  cold  ;  hence  it  has  been  employed  in  the  form 
of  spray,  as  a  local  ansesthetic.  It  combines  with  alcohol  and 
chloroform  in  all  proportions,  and  dissolves  in  ten  times  its 
volume  of  water. 

Medical  Properties  and  Action. — Ether  is  a  diffusible  stimu- 
lant, antispasmodic,  anodyne  and  anaesthetic.  It  is  adminis- 
tered internally  in  the  form  of  ether  or  of  Hoffman's  Anodyne, 
compound  spirit  of  ether — Spiritiis  Etheris  Conipositns  (com- 
posed of  ether,  Oss,  ethereal  oil,  f5vj,  and  alcohol,  Oj),  also, 
in  the  form  of  spirit  of  nitrous  ether,  Spiritus  Etheris  Nitrosi, 
and  known  as  sweet  spirit  of  nitre  (a  solution  of  nitrous  ether 
in  alcohol). 

When  ether  is  taken  into  the  stomach,  it  causes  a  cooling 
sensation,  after  the  subsidence  of  the  burning,  which  is  quickly 


224  DENTAL  MEDICINE. 


diffused  over  the  body ;  increased  action  of  the  heart,  flushing 
of  face  and  warmth  of  surface  follow  in  a  few  minutes ;  the 
senses  are  quickly  excited;  the  mind  becomes  more  active, 
and  the  phenomena  of  alcoholic  intoxication  result,  which 
soon  pass  away,  leaving  a  feeling  of  calmness  and  sleep. 

Therapeutic  Uses. — Ether  is  employed  internally  as  an  anti- 
spasmodic and  anodyne,  for  angina  pectoris,  hysteria,  asthma, 
flatulence,  cramp  of  stomach  and  bowels,  syncope,  epilepsy, 
hiccough,  nervous  or  hysterical  headache.  Hoffmann's  Ano- 
dyne possesses  the  antispasmodic  and  stimulating  effects  of 
ether,  and  the  anodyne  effects  of  ethereal  oil,  or  oil  of  wine, 
and  is  also  carminative. 

The  Spirit  of  Nitrous  Ether  is  antispasmodic,  diaphoretic, 
and  diuretic,  and  is  employed  in  febrile  affections,  dropsies, 
etc.,  etc. 

Dose — Of  ether,  f3ss  to  f3j ;  of  Hoffmann's  Anodyne,  f5ss 
to  fSij,  in  sweetened  water;  of  spirit  of  nitrous  ether,  f3ss  to 
f^ss. 

Dental  Uses. — Ether  is  employed  as  a  general  and  local 
anaesthetic ;  as  a  topical  anodyne  in  neuralgia  and  odontalgia, 
for  which  purpose  it  is  generally  combined  with  other  agents ; 
in  aphthse  and  stomatitis;  as  a  counter-irritant,  evaporation 
being  prevented. 

Sulphuric  Ether  as  an  Anesthetic  Agent. — Sulphuric 
ether  is  generally  considered  to  be  a  safer  anaesthetic  agent 
than  chloroform,  as  but  comparatively  few  deaths  have  resulted 
from  its  inhalation.  The  discovery  of  its  anaesthetic  properties 
was  first  made  in  1844,  by  Dr.  Horace  Wells,  a  practicing 
dentist,  of  Hartford,  Conn. ;  and  Dr.  Morton,  of  Boston,  also 
a  dentist,  first  demonstrated  the  application  of  its  anaesthetic 
properties  in  dentistry  and  surgery,  in  1846. 

As  the  physiological  actions  of  both  ether  and  chloroform 
are  similar,  they  may  be  considered  as  follows  :  When  the 
vapor  of  ether  or  chloroform  is  inhaled,  the  first  effect  is  faucial 
irritation,  to  a  greater  or  less  degree,  according  to  the  strength 
of  the  agent  employed,  a  feeling  of  suffocation,  with  cough,  a 
flow  of  mucus  and  the  reflex  act  of  swallowing.     The  desire 


ETHER— ANyESTHESIA.  225 

for  air  may  cause  more  or  less  struggling,  especially  in  the 
case  of  children.  The  sensibility  of  the  glottis,  however,  is 
soon  relieved,  the  cough  ceases,  and  the  inhalation  of  the 
agent  proceeds  without  further  resistance. 

The  primary  effect  is  a  general  exhilaration  ;  and,  in  the 
case  of  ether  especially,  it  is  often  one  of  excitement,  which, 
in  the  majority  of  cases,  may  continue  for  a  short  time  only, 
while  in  other  cases,  it  may,  from  its  duration  and  violence, 
give  rise  to  considerable  trouble.  But,  if  the  inhalation  can  be 
continued  and  this  stage  of  excitement  passed  over,  insensi- 
bility soon  occurs.  The  pulse  increases  in  frequency,  the  re- 
spirations become  more  rapid,  and  may  assume  a  convulsive 
character.  There  is  flushing  of  the  face,  cerebral  intoxication, 
to  a  greater  or  less  degree,  according  to  the  temperament, 
such  as  talking,  laughing,  singing,  crying,  etc.  In  those  of  a 
mercurial  or  hysterical  disposition  this  stage  of  excitement  is 
more  pronounced  and  persistent,  and  during  its  continuance 
sensibility  to  pain  is  considerably  diminished,  although  the 
sense  of  touch  is  still  preserved,  while  those  of  taste  and  smell 
are  lost,  and  complete  insensibility  soon  follows. 

When  the  patient  is  of  a  full  habit,  and  in  robust  health, 
and  the  inhalation  of  the  anaesthetic  agent  has  been  rapid,  the 
stage  of  complete  insensibility  is  preceded  by  a  convulsive 
stage,  during  which  there  is  rigidity  of  the  voluntary  muscles, 
stertorous  breathing  and  lividity  of  the  face.  If  the  inhalation 
of  the  agent  be  still  further  continued,  the  tetanic  rigidity  of 
the  muscles  subsides,  the  lividity  of  the  face  disappears,  the 
breathing  becomes  quiet,  complete  muscular  relaxation  ensues, 
power  of  movement  is  lost  as  shown  by  the  arm,  when  raised, 
dropping  without  resistance,  and  the  conjunctiva  of  the  eye, 
under  mechanical  irritation,  being  perfectly  insensible  to  pain. 
During  complete  anaesthesia  the  surface  of  the  face  is  cool  and 
bathed  in  abundant  perspiration  ;  the  countenance  is  calm,  the 
eyes  closed  and  the  pupils  somewhat  contracted,  the  respiration 
easy  and  the  pulse  slower.  The  functions  of  respiration  and 
circulation  continue,  all  others  being  suspended.  From  such 
a  condition  the  patient  will  soon  emerge,  provided  the  further 
15 


226  DENTAL   MEDICINE. 


inhalation,  of  the  agent  be  stopped ;  on  the  other  hand,  if  the 
inhalation  be  continued,  the  functions  of  respiration  and  circu- 
lation will  be  suspended,  and  life  will  end  with  the  cessation 
of  the  action  of  the  heart  and  the  respiratory  organs.  Sudden 
death  from  the  inhalation  of  anaesthetic  agents  is  due  to 
paralysis  of  the  cardiac  ganglia.  When  death  occurs  during 
the  stage  of  rigidity  and  stertorous  breathing,  it  is  due  to 
tetanic  fixation  of  the  respiratory  muscles  and  obstruction  of 
the  pulmonary  circulation,  accumulation  of  venous  blood  in 
the  heart  and  the  arrest  of  the  heart's  action. 

Death  may  also  ensue  by  paralysis  of  the  respiratory  mus- 
cles during  the  stage  of  complete  muscular  relaxation  ;  also 
by  paralysis  of  the  heart  during  complete  insensibility,  the 
motor  ganglia  being  paralyzed. 

Death  may  also  occur  from  depression  of  the  functions  and 
the  shock  of  the  accident,  or  of  the  surgical  operation. 

Mr.  Woodhouse  Braine  divides  anaesthetics  into  two  classes : 
(i)  Those  which  produce  death  through  the  lungs  as  well  as 
through  the  heart ;  this  class  includes  chloroform,  bichloride 
of  methylene,  dichloride  of  ethidene,  and  many  others  of  the 
chlorine  series  ;  (2)  those  which  produce  death  through  the 
lungs  alone,  the  heart's  action  continuing  for  some  time  after 
respiration  has  quite  ceased  :  this  class  includes  ether  and 
nitrous  oxide  ;  and  he  says,  that  in  choosing  an  anaesthetic 
three  factors  are  to  be  considered  :  (i)  The  nature  of  the 
operation  ;  (2)  the  amount  of  insensibility  necessary  ;  (3)  the 
length  of  time  during  which  insensibility  has  to  be  kept  up  ; 
and  he  sums  up  as  follows  :  (i)  It  is  well  to  avoid  all  anaes- 
thetics which  tend  to  depress  the  heart's  action ;  {2)  for  short 
operations  nitrous  oxide  is  the  best  agent ;  (3)  for  long  opera- 
tions, except  where  it  is  desirable  to  avoid  hemorrhage,  or 
where  the  cautery  is  used,  ether  answers  perfectly ;  (4)  the 
best  time  for  operating  is  the  early  morning;  (5)  nitrite  of 
amyl  is  the  best  cardiac  stimulant. 

The  Administration  of  Anaesthetics. — To  administer 
ether  or  chloroform,  take  a  folded  piece  of  lint,  of  three  or  four 
thicknesses,  and  of  a  size  that  can  be  held  conveniently  in  the 


ETHER— ANESTHESIA.  227 


hollow  of  the  fingers  and  palm  of  the  hand  ;  and  on  it  pour 
the  ansesthetic  agent — half  an  ounce  of  ether  or  a  drachm  of 
chloroform.  Some  prefer  a  large  napkin  or  towel,  folded  in 
the  form  of  a  cone,  with  an  opening  of  an  inch  or  an  inch  and 
a  half  at  the  apex,  for  the  admission  of  air.  The  advantage, 
however,  of  the  lint  over  the  folded  napkin  is,  that  by  holding 
the  lint  in  the  hand  but  little  evaporation  occurs.  To  give 
sufficient  air  to  the  patient  when  beginning  the  administration 
of  ether.  Dr.  D.  B.  Keefe  recommends  the  use  of  a  large  towel, 
folding  it  first  five  times  lengthwise,  and  placing  a  piece  of  paper 
the  full  length  between  the  outside  folds,  then  roll  it  up  into  a 
cylinder,  the  size  to  be  governed  by  the  face  of  the  patient: 
it  should  be  large  enough  to  cover  the  face,  but  not  too  large. 
This  makes  a  cylinder  open  at  both  ends,  full  size.  Then 
saturate  the  lower  part  of  the  cylinder,  that  comes  against  the 
face,  with  the  ether  and  apply  it  to  the  face,  and  as  the  other 
end  is  open  the  patient  receives  considerable  air  as  well  as  the 
ether  vapor.  Before  commencing  the  inhalation,  the  condition 
of  the  pulse  should  be  ascertained  by  placing  the  middle  finger 
of  the  left  hand  on  the  left  temporal  artery,  and  at  the  same 
time  endeavor  to  reassure  the  patient  and  allay  fear  by  cheerful 
words.  The  clothes  should  be  loose,  and  artificial  teeth,  if  any 
are  worn,  as  well  as  pins,  if  the  habit  of  keeping  them  in  the 
mouth  is  indulged  in,  should  be  removed  before  the  adminis- 
tration of  the  anaesthetic  is  commenced.  The  inhalation  should 
be  commenced  by  holding  the  moistened  lint  or  towel  three 
or  four  inches  from  the  patient's  face,  directing  him  to  breathe 
quite  naturally,  always  remembering  that  a  strong  atmosphere 
in  the  early  stages  of  the  inhalation  is  dangerous,  and  care- 
fully watching  for  coughing  or  acts  of  swallowing,  when,  if  any 
such  occur,  the  lint  or  towel  should  be  moved  further  away, 
and  approached  again  more  gradually.  If  the  patient  shows 
no  signs  of  the  anaesthetic  vapor  being  too  strong,  the  lint  or 
towel  may  be  gradually  brought  to  within  an  inch  and  a  half 
of  the  patient's  mouth  and  nostrils;  and  to  still  more  concen- 
trate the  atmosphere,  if  lint  is  used,  the  hand  holding  it  may 
be  covered  with  one  fold  of  an  ordinary  large  napkin,  which 


228  DENTAL   MEDICINE. 


may  hang  loose  over  the  mouth  and  chin,  but  should  be  so 
arranged  above  that  the  patient's  eyes  and  forehead  may 
remain  uncovered  and  visible.  The  inhalation  should  be 
commenced  cautiously,  by  instructing  the  patient  to  breathe 
quite  naturally,  and  to  obey  any  direction  to  raise  the  hand  or 
open  the  eyes. 

When  the  inhalation  has  fairly  commenced,  it  should  be 
continued  until  there  is  no  winking  when  the  margins  of  the 
eyelids  are  touched,  or  the  hand  cannot  be  raised,  and  the 
limbs  are  perfectly  relaxed,  when  the  patient  is  ready  for  the 
operation;  what  is  termed  the  "surgical  period"  having  arrived. 
An  inhalation  with  chloroform  generally  takes  about  four 
minutes ;  often  more ;  seldom  less.  With  ether,  the  time 
required  is  longer  and  the  quantity  of  the  agent  greater. 

It  should  also  be  remembered  that,  in  summer,  chloroform 
and  ether  evaporate  more  readily  than  in  the  colder  seasons. 

The  operator  should  devote  his  undivided  attention  to  the 
patient,  during  the  inhalation  of  anaesthetics.  <  One  finger 
should  be  kept  on  the  pulse,  and  the  respiration  should  be 
carefully  noted ;  for  the  latter  is  of  more  importance  than  the 
former,  although  the  pulse  is  by  no  means  to  be  neglected. 
When  the  patient  becomes  excited,  he  should  be  watched  very 
closely,  and  if  the  respiration  becomes  proportionately  quick- 
ened, so  must  the  vapor  of  the  anaesthetic  be  proportionately 
weakened,  by  withdrawing  the  lint  or  towel  slightly  from  the 
face. 

When  the  muscles  become  rigid,  and  the  patient  holds  his 
breath  and  becomes  livid,  the  anaesthetic  should  be  given  very 
weak  indeed,  as  such  a  state  of  semi-asphyxiation,  due  to  the 
suspension  of  respiration,  is  often  followed  by  extreme  rapidity 
and  depth  of  respiration,  and  a  dangerous  condition  is  apt  to 
supervene,  because  anaesthesia  is  added  to  asphyxia.  The 
cumulative  action  of  these  general  anaesthetics  should  also  be 
remembered,  for  a  state  of  narcosis  frequently  intensifies  for 
half  a  minute  or  more  after  the  suspension  of  the  administra- 
tion, which  is  due  to  the  vapor  of  the  anaesthetic  which  was  in 
the  lungs  entering  the  blood  after  the  administration  ceases. 


ETHER— AN/ESTHESIA.  229 

Dr.  Buxton  points  out  that  even  admitting  greater  danger 
from  chloroform,  its  use  is  indicated  in  the  following  circum- 
stances : 

a.  In  protracted  operations  about  the  mouth,  jaws,  nose, 
or  pharynx,  which  necessitates  the  mouth  and  nose  being  un- 
covered. 

b.  All  operations  needing  the  employment  of  the  actual 
cautery,  or  lighted  candles,  lamps,  etc.,  in  the  vicinity  of  the 
mouth  ;  ether  being  highly  inflammable,  and  when  mixed  with 
air,  detonating,  so  that  the  incautious  bringing  of  the  appara- 
tus near  a  light  may  lead  to  grave  consequences. 

c.  Persons  who  are  suffering  from  bronchitis,  and  those 
liable  to  that  complaint;  the  emphysematous  (if  the  condition 
be  very  pronounced)  and,  as  a  rule,  asthmatics  bear  ether  badly, 
since  it  creates  cough,  and  may  clog  the  bronchial  tubes  with 
a  quantity  of  excessive  secretion. 

d.  In  renal  disease,  when  extensive,  ether  is  said  to  induce 
suppression  of  urine ;  so  that  if  given  at  all  in  these  cases,  it 
should  be  with  the  utmost  caution. 

e.  The  vascular  excitement  to  which  ether  gives  rise,  con- 
traindicates  its  use  for  persons  whose  arteries  are  presumably 
brittle,  etc. 

f.  In  infants  and  very  young  children. 

g.  As  ether  always  provokes  coughing  and  rapid  breathing, 
it  should  not  be  used  when  these  are  prejudicial  to  the  patient 
or  to  the  success  of  the  operation. 

h.  The  presence  of  brain  tumors,  intestinal  obstruction,  and 
cancerous  tumors  is  by  some  considered  contra-indicatory  of 
ether.  To  these  the  Chronicle  adds  two  other  large  groups  of 
conditions,  viz. :  ist,  all  cases  of  brain  surgery;  2d,  where  the 
circumstances  of  the  patient  or  the  requirements  of  the  opera- 
tion are  such  as  to  demand  the  securing  of  perfect  rest  by  the 
free  use  of  opiates,  ether  must  be  avoided  on  account  of  its 
action  on  the  kidneys. 

Prof  J.  J.  Chisholm,  of  the  University  of  Maryland,  gives 
the  following  five  simple  rules  for  the  administration  of  chloro- 
form, and  which  will  apply  to  ether  also  : — 


230  DENTAL   MEDICINE. 


"  I.  I  always,  without  a  single  exception,  give  a  strong 
drink  of  whiskey,  from  one  to  two  ounces,  to  every  adult  to 
whom  I  intend  to  administer  chloroform.  This  is  done  a  few 
minutes  before  the  operation. 

"  2.  Always  loose  the  neck  and  chest  clothing,  so  as  to  have 
no  impedient  to  respiration. 

"3.  Only  administer  chloroform  in  the  recumbent  posture^ 
with  body  perfectly  horizontal  and  head  on  a  low  pillow,  this 
pillow  to  be  removed  as  the  anaesthesia  progresses. 

"  4.  Give  chloroform  on  a  thin  towel,  folded  m  conical  form, 
with  open  apex,  so  that  the  vapor,  before  inhalation,  will  be 
freely  diluted  with  atmospheric  air.  In  holding  this  cone  over 
the  face  of  the  patient,  at  some  little  distance  from  the  nose, 
place  the  fingers  under  the  borders  of  the  cone,  for  the  double 
purpose  of  allowing  the  air  to  enter  freely,  and  also  to  prevent 
the  chloroform  liquid  on  the  towel  from  coming  in  contact 
with  the  skin  of  the  patient's  face,  and  thereby  avoid  its  blister- 
ing effects. 

"  5.  Should  loud  snoring  occur,  force  up  the  chin.  This 
manipulation,  by  straightening  the  air  passages  from  the  nose 
to  the  larynx,  makes  easy  breathing.  The  forcible  elevation 
of  the  chin  is  far  better  in  every  respect  than  pulling  out  the 
tongue.  It  is  easier  of  application,  more  quickly  done,  requires 
no  instrument,  and  is  much  more  efficient  in  removing  the  im- 
pediment to  respiration. 

"While  operating,  I  have  constantly  in  view  both  the  color 
of  the  face  and  the  respiration  of  the  patient,  which  I  consider 
even  more  important  for  the  surgeon  to  observe  than  to  feel 
the  pulse."  (See  "  Chloroform  "  for  further  directions  and  pre- 
cautions to  be  observed  during  the  administration  of  this  agent.) 

Dr.  H.  A.  Hare  states  that  if  during  anaesthesia,  respiration 
stops,  he  has  found  that  in  a  large  number  of  instances,  both 
in  man  and  in  the  lower  animals,  the  free  use  of  ether  poured 
upon  the  belly  causes  so  great  a  shock,  by  the  cold  produced 
by  its  evaporation,  as  to  cause  a  very  deep  inspiration,  which 
is  often  followed  by  the  normal  respiratory  movements. 

Dr.  H.  I.  Neilson  gives   the  following  conclusions  concern- 


ETHER— ANESTHESIA.  231 


ing   the  pupil   as  a   guide  in  the  administration  of  chloro- 
form : 

1.  The  first  effect  of  chloroform  narcosis  on  the  pupils 
consists  in  a  dilatation  which  varies  in  intensity  and  duration 
in  different  individuals.  As  the  anaesthesia  becomes  more 
profound  the  pupils  begin  to  contract  and  finally  become  very 
small  and  immovable.  If  now  the  chloroform  is  pushed  still 
further,  a  sudden  dilatation  occurs,  which  is  the  result  of 
asphyxia,  from  which  the  patient  seldom  recovers. 

2.  As  long  as  the  pupil  is  observed  to  dilate  in  response 
to  sensory  stimuli,  such  as  pinching  the  skin,  the  anaesthesia 
is  not  yet  sufficient  to  allow  the  commencement  of  the  opera- 
tion. 

3.  As  soon  as  the  pupil  becomes  strongly  contracted  and 
immovable,  the  administration  of  the  anaesthetic  must  be  sus- 
pended until  a  commencing  dilatation  is  observed,  and  the 
patient  must  be  held  at  just  this  point  as  long  as  the  operation 
continues. 

4.  Vomiting  causes  a  dilatation  similar  to  that  occurring 
as  the  patient  emerges  from  the  narcotic  condition,  but  it  is 
usually  more  sudden  in  the  former  case.  The  contraction  of 
the  pupils  does  not  appear  to  begin  until  the  blood-pressure 
is  somewhat  reduced,  and  the  dilatation  proceeds  pari  passu 
with  the  increase  in  the  blood-pressure.  He  therefore  regards 
the  appearance  of  the  pupil  as  a  very  reliable  guide  for  the 
administration  of  chloroform,  as  he  is  enabled  to  judge  accu- 
rately concerning  the  condition  of  the  patient. 

When  ether  or  chloroform  is  administered  for  the  extraction 
of  teeth,  the  operation  should  be  performed  in  a  dental  chair 
so  constructed  as  to  admit  of  the  patient  being  placed  in  as 
horizontal  a  position  as  is  possible  to  operate  successfully, 
and  every  instrument  it  is  necessary  to  use  should  be  within 
reach  of  the  hand  of  the  operator.  As  soon  as  the  operation 
is  completed  the  head  of  the  patient  should  be  gently  inclined 
to  the  side,  so  as  to  permit  the  blood  to  run  from  the  mouth 
and  not  pass  down  the  throat.  Any  considerable  change  in 
the  position  of  the  patient  should  be  avoided  until  recovery 


232  DENTAL  MEDICINE. 


has  taken  place.  Fresh  air  should  be  admitted  by  lowering 
the  window,  and  the  patient  freely  supplied  with  it  by  means 
of  a  fan. 

M.  Paul  Bert  instituted  experiments  with  mixtures  of  ether, 
chloroform  and  air,  or  nitrous  oxide  and  air,  or  nitrous  oxide 
and  oxygen,  under  pressure,  which  he  claimed  diminished  the 
danger  without  lessening  the  advantages  of  the  anaesthetic. 
A  proportion  of  eight  per  cent.,  after  six  or  seven  minutes, 
sufficed  to  induce  and  maintain  a  state  of  surgical  coma  for 
fifteen  to  thirty  minutes,  and  the  symptoms  of  the  stage  of 
exhilaration  were  much  less  marked  than  usual.  He  also 
claimed  that  there  is  an  absence  of  the  feeling  of  suffocation 
common  to  the  old  method;  that  the  face  retains  its  natural 
color;  that  respiration  is  regular,  but  somewhat  quickened  and 
sometimes  snoring;  that  the  pulse  shows  no  marked  disturb- 
ance; that  the  buccal  secretion  is  scanty;  that  the  patient  is 
spared  violent  coughing,  which  often  seems  to  initiate  the 
after  vomiting;  that  the  return  to  consciousness  from  complete 
anaesthesia  takes  from  eight  to  ten  minutes;  that  the  quantity 
of  chloroform  used  is  small — in  one  case,  where  the  anaesthesia 
lasted  half  an  hour,  it  was  only  five  grammes;  that  by  means 
of  the  apparatus  used  the  patient  escapes  any  local  irritation 
of  the  skin,  and  the  operator  does  not  receive  the  fumes  of  the 
drug  in  his  face.  The  appliance  used  in  Bert's  method  is  the 
invention  of  Dr.  H.  Martin  for  analyzing  the  gases  of  respira- 
tion, and  consists  of  a  pair  of  reservoirs  connected  with  a 
caoutchouc  mouth-piece,  and  containing  the  required  mixture 
of  air  and  chloroform.  By  a  special  contrivance  a  constant 
supply  of  the  anaesthetic  is  maintained,  to  make  up  for  the  loss 
by  inhalation,  and  the  pressure  within  the  reservoirs  remains, 
under  all  circumstances,  equal  to  that  of  the  surrounding  air ; 
and  the  respiratory  movements  can  be  accurately  watched  by 
means  of  a  water  manometer  and  scale  affixed  to  the  instru- 
ment. In  operations  on  the  mouth,  anaesthesia  is  first  pro- 
duced by  the  aid  of  the  mouth-piece,  and  afterward  kept  up 
by  an  occasional  jet  of  the  mixed  vapor  sent  into  the  back  of 
the  mouth. 


ETHER— ANESTHESIA.  233 

Some  eminent  surgeons,  however,  among  the  number 
Messrs.  Gossehn  and  Richet,  consider  Bert's  method  a  dan- 
gerous one,  and  the  latter  states  of  the  cases  at  the  St.  Louis 
Hospital,  Paris,  which  he  witnessed,  one  in  three  was  accom- 
panied with  vomiting,  discomfort,  and,  on  one  occasion,  with 
great  excitement. 

What  has  been  styled  "  vitalized  air,"  is  the  vapor  from  a 
mixture  composed  of  equal  parts  of  chloroform  and  alcohol 
combined  with  the  nitrous  oxide  gas.  The  vapor  from  two  or 
three  drops  of  the  chloroform  and  alcohol  mixture  is  used  with 
each  gallon  of  gas,  the  anaesthetic  effect  of  which,  it  is  claimed, 
is  more  lasting,  and  at  the  same  timeless  dangerous,  than  from 
either  of  the  two  agents  alone.  An  apparatus  for  combining 
these  two  agents  is  in  use,  which  is  attached  to  the  gas  cylin- 
der, in  place  of  the  ordinary  connection. 

The  administration  of  anaesthetics  through  the  nose  has 
been  suggested  by  Dr.  B.  C.  A.  Windle,  of  England,  a  pecu- 
liar instrument  being  employed  for  pumping  the  vapor  of  the 
ansesthetic  through  a  tube  which  passes  into  one  nostril;  wings, 
to  close  the  outer  surface  of  the  nostril  containing  the  tube 
and  the  opposite  surface  of  the  septum  nasi,  are  attached  to 
the  tube,  so  that  air  may  pass  through  the  passage  unoccluded 
by  the  tube.  The  inventor  of  this  method  claims  that  by  its 
use  perfect  anaesthesia  can  be  maintained  throughout  an  opera- 
tion about  the  face,  of  any  length,  without  interfering  with  the 
operator's  actions ;  also,  that  in  operations  about  the  mouth 
and  palate  the  patient  can  be  maintained  at  that  point  of  anaes- 
thesia which  may  be  considered  desirable,  and  that  the  supply 
can  be  regulated. 

Dr.  Axel  Yversen,  of  Copenhagen,  suggested  etherization 
by  the  rectum,  the  vapor  being  conducted  to  the  rectum  by  a 
rubber  tube  (attached  to  a  bottle  containing  the  ether,  in  a 
water  bath  of  120°),  terminating  in  a  recurrent  catheter,  the 
free  or  recurrent  end  being  closed  by  pressure  of  the  thumb 
during  the  inflation  of  the  bowel ;  the  expiratory  act  being 
performed  by  removing  this  pressure  and  the  water  bath.  The 
principal  advantage  this  method  appears  to  possess  is  that  it 


234  DENTAL  MEDICINE. 

permits  operations  on  the  face  without  the  ordinary  obstacles 
of  the  common  method. 

Dr.  Thomas  Fillebrown  suggests  a  new  apparatus  for  main- 
taining anaesthesia  without  a  face-piece,  and  with  the  mouth 
open.  The  apparatus  consists  of  a  bellows,  connected  by  rub- 
ber tubing  with  the  long  tube  of  a  i2-ounce  wash-bottle,  with 
a  stop-cock  to  regulate  the  flow  of  air.  From  the  bottle  ex- 
tends a  half-inch  rubber  tube  to  the  patient.  The  bellows  is 
inflated,  and  the  stop-cock  opened  so  as  to  allow  the  air  to 
bubble  up  freely  through  the  ether,  and  to  become  saturated 
with  ether  vapor.  The  etherized  air  is  then  discharged  through 
the  second  tube  a  few  inches  from  the  patient's  face.  It  is 
claimed  that  such  an  application  of  ether  will  maintain  com- 
plete anaesthesia  for  any  length  of  time,  and  not  interfere  in  the 
least  with  any  operation  in  or  about  the  mouth ;  nor  will  the 
surplus  vapor  discharged  into  the  air  sensibly  affect  either  the 
operator  or  the  assistants ;  also,  that  the  anaesthesia  can  be 
maintained  from  one-half  hour  to  one  hour  and  a-half  without 
intermitting  the  operation  at  all  on  account  of  the  anaesthesia  ; 
that  this  method  is  not  wasteful. 

The  Dangers  of  Anesthesia. — The  conditions  rendering 
general  anaesthetics  dangerous  are  fatty  degeneration  of  the 
heart  (a  prominent  contra-indication) ;  previous  alcoholic  habits ; 
brain  tumors  and  degenerations ;  respiratory  obstruction  from 
swollen  epiglottis,  enlarged  tonsils,  oedema  glottidis,  laryngeal 
paralysis,  thoracic  tumors  or  aneurism ;  emphysema  and  ob- 
structed pulse  circulation  from  engorgement  of  right  heart 
and  deficient  heart  power;  valvular  lesions  ;  incomplete  anaes- 
thesia during  painful  surgical  operations,  causing  death  from 
shock,  as  the  result  of  peripheral  irritation.  Muscular  debility 
and  weakness  from  exhaustion,  if  otherwise  uncomplicated, 
are  considered  to  be  rather  aids  to  anaesthesia  than  contra- 
indications. 

Preventive  Measures  Against  the  Dangers  of  Anes- 
thesia.— A  thorough  examination  for  sources  of  danger  should 
always  be  made  previous  to  the  administration  of  the  anaes- 
thetic.    An  anaesthetic  should  never  be  administered  on  a  full 


ETHER— ANESTHESIA.  235 

stomach,  as  an  anaesthesia  of  the  glottis  prevents  the  expulsion 
of  vomited  matter  from  the  larynx,  in  case  it  enters  by  regur- 
gitation. An  anaesthetic  should  never  be  administered  after 
long  fasting,  as  absence  of  nutrition  may  tend  toward  cardiac 
paralysis.  One  or  two  ounces  of  whiskey  should  be  adminis- 
tered immediately  before  the  operation.  All  excitement  should 
be  avoided,  to  the  patient,  from  fear,  sight  of  instruments,  too 
many  spectators,  etc.,  all  of  which  tend  to  induce  shock.  All 
appliances  for  resuscitation  should  be  at  hand,  and  plenty  of 
fresh  air  be  available  during  the  inhalation.  In  using  chloro- 
form mix  only  three  and  a-half  per  cent,  of  the  vapor  with  air, 
to  insure  safety.  In  the  administration  of  ether  the  respira- 
tions, according  to  some  authorities,  alone  need  be  watched: 
in  chloroform,  however,  both  the  respirations  and  the  pulse 
should  be  carefully  noted. 

Treatment  of  Dangerous  Symptoms  of  An/esthesia. — 
The  suspension  of  the  heart's  action  necessitates  the  immediate 
withdrawal  of  the  vapor  and  the  immediate  inversion  of  the 
patient,  according  to  N^laton's  method.  The  failure  of  respi- 
ration necessitates  the  forcing  up  of  the  chin,  or  the  forcible 
drawing  out  of  the  tongue  to  lift  the  epiglottis;  the  practice  of 
artificial  respiration  by  the  Sylvester  method,  and  by  faradiza- 
tion of  the  respiratory  muscles  ;  the  inhalation  of  gtt.  iij  to  gtt. 
iv  of  nitrite  of  amyl ;  ammonia  to  the  nostrils  ;  galvanism  (the 
positive  pole  being  placed  to  the  nostril,  and  the  negative  pole 
over  the  diaphragm,  to  excite  a  reflex  action  between  the  fifth 
pair  and  the  pneumo-gastric,  or  the  poles  may  be  placed  directly 
over  both  phrenic  nerves,  on  a  line  with  the  fourth  cervical 
vertebra,  in  order  to  stimulate  respirations;  or  one  pole  maybe 
placed  over  the  upper  dorsal  spinous  process,  and  the  other 
pole  over  the  apex  of  the  heart,  to  induce  cardiac  contraction). 
Artificial  warmth  should  be  applied,  but  no  cold  applications. 

The  inversion  of  the  body  according  to  Nelaton's  method, 
and  artificial  respiration,  according  to  Sylvester's  method  or 
Marshall  Hall's  ready  method,  or  Howard's  method,  are  safe 
and  are  the  most  promising  expedients.  A  simple  method  of 
producing  artificial  respiration  is  as  follows  : — 


236 


DENTAL  MEDICINE. 


"  With  outspread  palms,  press  the  front  of  the  chest  forcibly- 
down,  whilst  an  assistant  at  the  same  time  presses  the  abdo- 
men. Make  these  movements  not  oftener  than  fifteen  times 
in  the  minute." 

DR.  H.  R.  SYLVESTER'S  METHOD    OF  RESUSCITATION. 

"7l5>  Adjust  the  Patienfs  Position. — Place  the  patient  on  his 
back,  on  a  flat  surface;  raise  and  support  the  head  and  should- 
ers on  a  small,  firm  cushion,  or  folded  article  of  dress,  placed 


under  the   shoulder-blades;  remove  all  tight   clothing  about 
the  neck  and  chest. 

"  To  Maintain  a  Free  Entrance  of  Air  i)ito  the  Windpipe. — 
Cleanse  the  mouth  and  nostrils ;  open  the  mouth ;  draw  forward 


the  patient's  tongue,  and  keep  it  forward ;  an  elastic  band  over 
the  tongue  and  under  the  chin  will  answer  the  purpose. 

"To  Imitate  the  Movements  of  Breatliing : — 

'^ First,  Induce  htspiration.  Place  yourself  at  the  head  of  the 
patient;  grasp  his  arms;  raise   them   upward   by  the  sides  of 


ETHER— ANESTHESIA.  .  237 

his  head;  stretch  them  steadily  but  gently,  upward  and  back- 
ward, for  two  seconds.  By  this  means  fresh  air  is  drawn  into 
the  lungs,  by  raising  the  ribs. 

"Seco7zdly,  Induce  Expiration.  Immediately  turn  down  the 
patient's  arms,  and  press  them  firmly,  but  gently,  downward 
against  the  sides  of  his  chest,  for  two  seconds.  By  this 
means  foul  air  is  expelled  from  the  lungs,  by  depressing  the 
ribs. 

''Thirdly,  Continue  these  Movements.  Repeat  these  move- 
ments alternately,  deliberately  and  perseveringly,  fifteen  times 
in  a  minute,  until  a  spontaneous  effort  to  respire  be  perceived. 
By  these  means  an  exchange  of  air  is  produced  in  the  lungs, 
similar  to  that  effected  by  natural  aespiration." 

MARSHALL  HALL'S   READY   METHOD   IN  ASPHYXIA. 

"  1st.  Treat  the  patient  instantly,  on  the  spot,  in  the  open  air, 
freely  exposing  the  face,  neck  and  chest  to  the  breeze,  except 
in  severe  weather. 

2d.  In  order  to  clear  the  tJiroat,  place  the  patient  gently  on 
the  face,  with  one  wrist  under  the  forehead,  that  all  fluid,  and 
the  tongue  itself,  may  fall  forward,  and  leave  the  entrance  into 
the  windpipe  free. 

"  3d.  To  excite  respiration,  turn  the  patient  slightly  on  his 
side,  and  apply  some  irritating  or  stimulating  agent  to  the 
nostrils,  as  Veratrine,  dilute  Ammonia,  etc. 

"  4th.  Make  the  face  warm  by  brisk  friction ;  then  dash 
cold  water  upon  it. 

"  5th.  If  not  successful,  lose  no  time  ;  but,  to  imitate  respira- 
tion, place  the  patient  on  his  face,  and  turn  the  body  gently, 
but  completely,  on  the  side  and  a  little  beyond ;  then  again  on 
the  face,  and  so  on,  alternately.  Repeat  these  movements 
deliberately  and  perseveringly,  fifteen  times  ojily  in  a  minute. 
(When  the  patient  lies  on  the  thorax,  this  cavity  is  compressed 
by  the  weight  of  the  body,  and  tvt'piration  takes  place.  When 
he  is  turned  on  the  side,  this  pressure  is  removed,  and  //aspira- 
tion occurs.) 

"  6th.  When  the  prone  position  is  resumed,  make  a  uniform 


238  .  DENTAL   MEDICINE. 


and  efficient  pressure  along  the  spine,  removing  the  pressure 
immediately  before  rotation  on  the  side.  (The  pressure  aug- 
ments the  ^jfpiration;  the  rotation  commences  zVzspiration.) 
Continue  these  measures. 

"  /th.  Rub  the  limbs  upivard,  with  firm  pressure  and  with 
energy.  (The  object  being  to  aid  the  return  of  venous  blood 
to  the  heart.) 

"  8th.  Substitute  for  the  patient's  wet  clothing,  if  possible, 
such  other  covering  as  can  be  instantly  procured,  each  by- 
stander supplying  a  coat  or  cloak,  etc.  Meantime,  and  from 
time  to  time,  to  excite  inspiration,  let  the  surface  of  the  body 
be  slapped  briskly  with  the  hand. 

'■'■  9th.  Rub  the  body  briskly  till  it  is  dry  and  warm,  then 
dash  cold  water  upon  it  and  repeat  the  rubbing. 

"  Avoid  the  immediate  removal  of  the  patient,  as  it  involves 
a  dangerous  loss  of  time  ;  also  the  use  of  bellows,  or  any  forc- 
ing instrument ;  also,  the  warm  bath  and  all  rough  treatment^ 

DR.  HOWARD'S  METHOD  OF  RESUCITATION. 

One  of  the  most  efficient,  as  well  as  the  most  recent  method, 
is  that  of  Dr.  Howard  for  performing  artificial  respiration. 

Position  of  Patient. — Face  upward,  a  hard  roll  of  clothing 
beneath  the  thorax,  with  shoulders  slightly  declining  over  it. 


(One  twist  of  handkerchief  around  the  crossed  wrists  will  keep 
them  there.)     Rip  or  strip  clothing  from  waist  and  neck. 


LOCAL  ANESTHESIA.  239 

Position  of  Operator.  —  Kneel  astride  the  patient's  hips  ; 
place  your  hands  upon  his  chest,  so  that  the  ball  of  each 
thumb  and  little  finger  rests  upon  the  inner  margin  of  the 
free  border  of  the  costal  cartilages,  the  tip  of  each  thumb 
near  or  upon  the  xiphoid  cartilage,  the  fingers  fitting  in  the 
corresponding  intercostal  spaces.  Fix  your  elbows  firmly, 
making  them  even  with  your  sides  and  hips  ;  then — 

Action  of  Operator. — Pressing  upward  and  inward  toward 
the  diaphragm,  use  your  knees  as  a  pivot,  and  throw  your 
weight  slowly  forward  two  or  three  seconds  until  your  faec 
almost  touches  that  of  the  patient,  ending  with  a  sharp  push, 
which  helps  to  jerk  you  back  to  your  erect  kneeling  position. 
Rest  three  seconds,  then  repeat  this  bellows-blowing  move- 
ment as  before,  continuing  it  at  the  rate  of  seven  to  ten  times 
a  minute,  taking  the  utmost  care  on  the  occurrence  of  a 
natural  gasp,  gently  to  aid  and  to  deepen  it  into  a  longer 
breath,  until  respiration  becomes  natural.  When  practicable, 
have  the  tongue  held  firmly  out  of  one  corner  of  the  mouth 
with  thumb  and  finger  armed  with  a  dry  cotton  rag. 

Very  frequently  during  the  early  stages  of  the  administra- 
tion of  an  anaesthetic  the  patient  may  "  forget  to  breathe," 
even  before  the  ability  to  perceive  peripheral  irritation  is  lost. 
Even  later  in  the  anaesthesia,  when  the  breathing  suddenly 
ceases,  instead  of  using  cold  water  externally  and  slapping 
the  patient  with  wet  towels,  Dr.  H.  A.  Hare  recommends 
pouring  a  quantity  of  ether  upon  the  belly,  the  shock  caused 
by  the  cold  produced  by  its  evaporation  bringing  on  a  very 
deep  inspiration,  followed  often  by  the  normal  respiratory 
movements. 

Local  Anesthesia. — The  fatality  attending  the  use  of 
general  anaesthetics  led  to  the  introduction  of  what  are 
termed  "  local  anaesthetics,"  some  of  which  depend  upon  the 
therapeutic  property  of  cold,  which  is  properly  an  anaesthetic 
only  when  it  freezes  the  part  to  which  it  is  applied.  The  use 
of  cold  for  such  a  purpose  must  necessarily  be  limited  to 
small  parts  of  the  body,  and  its  utility  depends  upon  the  ease 
and  rapidity  with  which  a  desired  spot  of  living  flesh  can  be 


240  DENTAL   MEDICINE. 


frozen,  in  other  words,  temporarily  deprived  of  its  vitality, 
without  inflicting  mechanical  injury  on  the  delicate  structure 
of  the  part. 

According  to  Dr.  Richardson,  the  proposer  of  the  method, 
the  principle  consists  in  directing  on  the  part  of  the  body  a 
volatile  liquid,  having  a  boiling  point  at  or  below  blood  heat, 
in  a  state  of  fine  subdivision  or  spray,  such  subdivision  being 
produced  by  the  action  of  air  or  other  gaseous  substance  on 
the  volatile  oil  to  be  dispersed.  When  it  falls  on  a  part  of 
the  body,  it  comes  with  force  into  the  most  minute  contact 
with  the  surface  upon  which  it  strikes. 

As  a  result,  there  is  rapid  evaporation  of  the  volatile  fluid, 
and  so  great  an  evolution  of  heat  force  from  the  surface  of  the 
part  to  which  the  spray  is  applied,  that  the  blood  cannot  sup- 
ply the  equivalent  loss.  The  part  consequently  dies  for  the 
moment,  and  is  insensible  ;  but  as  the  power  of  the  body  is 
unaffected,  the  blood,  as  soon  as  the  external  reducing  agency 
is  withdrawn,  quickly  makes  its  way  again  through  the  dead 
parts,  and  restoration  rapidly  occurs. 

The  fluids  used  are  ether,  of  a  specific  gravity  not  exceed- 
ing 0.723,  highly  rectified,  and  as  free  as  possible  from  either 
alcohol  or  water — what  is  known  as  "  absolute  ether  " — and 
rhigolene,  a  product  of  petroleum,  and  the  lightest  liquid 
known,  and  bromide  of  ethyl. 

When  a  current  of  the  volatile  liquid,  either  atomized  ether 
or  rhigolene,  comes  in  contact  with  the  skin  by  the  use  of  the 
spray  apparatus,  an  intense  degree  of  cold  is  produced,  which 
deprives  the  nerves  of  the  part  of  their  power  to  transmit 
impressions  to  the  sensorium.  For  the  Extraction  of  teeth, 
destruction  of  the  pulps  of  teeth,  opening  abscesses,  and  other 
minor  surgical  operations,  and  neuralgia  of  superficial  nerves, 
success  has  attended  the  use  of  such  local  anaesthetics.  The 
greatest  objections  to  such  a  method  of  inducing  local  anaes- 
thesia, are  the  great  pain  which  attends  the  first  application, 
and  the  unpleasant  burning  sensation  of  the  part  when  it  is 
recovering  from  the  freezing  process.  (See  Rhigolene.)  (See 
Aconite,  for  obtunding  mixture.) 


LOCAL  ANESTHESIA.  241 

Liquefied  chloride  of  methyl  dissolved  in  ether  and  care- 
fully applied  by  means  of  a  hair  pencil,  is  recommended  for  the 
painless  extraction  of  teeth,  the  opening  of  alveolar  abscesses, 
etc.,  etc.     (See  Cocaine  as  a  local  anaesthetic.) 

A  plan  of  local  anaesthesia  known  as  Voltaic  Narcotism  has 
been  suggested  by  Dr.  Richardson,  of  London.  It  consists 
in  passing  a  galvanic  current  through  a  narcotic  solution  held 
in  contact  with  the  part  to  be  operated  upon.  This  plan  ap- 
pears to  be  successful  only  where  the  cavity  of  the  tooth  to 
be  extracted  is  exposed. 

Electro-magnetism  has  also  been  employed  as  a  local  anaes- 
thetic, and  it  is  a  mooted  question  whether  it  relieves  pain  or 
complicates  the  sensations.  It  is  well,  however,  to  remember 
that  some  persons  are  so  peculiarly  constituted  as  to  render 
them  very  susceptible  to  the  influence  of  electricity.  Dr. 
Scott  describes  his  method  of  applying  electricity  for  the 
extraction  of  teeth  as  follows  :  "  Use  a  Kidder  electro  mag- 
netic machine,  or  any  other  giving  very  rapid  vibrations  of  ar- 
mature. Place  the  positive  electrode  on  the  gum  of  the  tooth 
to  be  extracted,  and  the  negative  in  the  patient's  hand,  or  at 
the  back  of  the  neck.  Start  with  a  light  current  and  gradually 
increase  the  strength  as  much  as  can  be  borne  without  pro- 
ducing pain.  The  electrode  applied  to  the  tooth  should  em- 
brace each  side,  the  better  to  convey  the  current.  For  this 
purpose  it  should  be  bifurcated  at  the  end  of  the  handle,  the 
arms  of  sufficient  length  for  convenience  in  operating.  At  the 
end  of  these  solder  small  disks  about  the  size  of  a  dime.  The 
handle  and  arms  must  be  insulated  to  prevent  the  current 
passing  off  at  any  other  point  than  the  disks.  Cover  the  disks 
with  thin  pads  of  fine  sponge.  A  cylinder  electrode,  also  cov- 
ered with  fine  sponge  or  cloth,  is  the  proper  one  for  the  hand. 
Moisten  each  with  saline  water.  Another  method  is  to  attach 
one  pole  of  the  battery  to  the  extracting  forceps,  the  handles 
of  which  are  well  insulated,  the  other  pole  being  held  in  the 
hands  of  the  patient.  As  soon  as  the  forceps  come  in  contact 
with  the  tissues  about  the  tooth  the  circuit  is  completed,  and 
the  electrical  effect  produced,  which  is  often  painful.  A  com- 
16 


242  DENTAL  MEDICINE. 


mittee  of  the  College  of  Dentists,  England,  in  a  recent  report 
upon  the  anaesthetic  value  of  electricity,  were  unanimous  that 
in  no  case  was  local  anaesthesia  produced  by  such  currents, 
but  that  the  effects  were  due  to  "diversion  of  sensation,  less 
difficulty  of  extraction  as  compared  with  other  extractions, 
syncope  more  or  less  marked,  and  differences  in  methods  of 
operating."       (See  Electricity  as  a  Therapeutic  Means,  etc.) 

Obtunding  mixtures,  consisting  of  a  combination  of  cocaine, 
pyrethrum,  aconite,  chloral,  veratria  and  alcohol,  or  chloro- 
form, aconite,  belladonna,  opium  and  carbolic  acid,  etc.,  have 
been  employed  to  produce  local  anaesthesia,  and  in  many  cases 
with  satisfactory  results.  (See  recipes  for  obtunding  mixtures 
and  local  anaesthetics.)  For,  although  entire  insensibility  to 
pain  cannot  in  all  cases  be  brought  about,  yet  some  dimi- 
nution of  it  may  be  effected  by  the  use  of  such  agents.  They 
have  the  merit,  at  least,  of  being  less  dangerous  than  the  gen- 
eral anaesthetics.  Such  pain-obtunding  mixtures  are  best 
applied  to  the  parts  about  the  neck  and  over  the  root  of  a 
tooth  by  means  of  a  simple  apparatus,  devised  by  Von  Bon- 
horst.  It  consists  of  two  small  metallic  cups,  attached  to  the 
free  ends  of  a  spring  some  seven  inches  long,  and  which  con- 
tain sponges  to  hold  the  liquid.  When  used  the  sponges  in 
the  cup  are  saturated  with  the  obtunding  mixture  and  applied 
b}^  pressing  them  on  the  gum  on  each  side  of  the  tooth  to  be 
removed,  where  they  are  retained  from  one-half  to  two  minutes. 
Previous  to  the  application  the  patient  should  be  cautioned 
against  swallowing  any  portion  of  the  mixture.  (See  Cocaine, 
hypodermic  use  of) 

Rapid  Breathing  as  a  Pain  Obtu7ider. — A  method  first  sug- 
gested by  Dr.  W.  G.  A.  Bonwell,  and  from  which  he  claims  a 
similar  effect  to  that  of  ether,  chloroform  and  nitrous-oxide 
gas  in  their  primary  stages,  and  to  render  the  patient  suffi- 
ciently unconscious  to  any  acute  pain  from  any  operation, 
where  the  time  consumed  is  not  over  from  twenty  to  thirty 
seconds.  "While  the  special  senses  are  in  partial  action,  the 
sense  of  pain  is  obliterated  and,  in  many  cases,  completely 
annulled,  consciousness    and    general    sensibility   being   pre- 


LOCAL   ANESTHESIA.  243 

• 

served."  ''  To  accomplish  this,  each  patient  must  be  instructed 
how  to  act  and  what  to  expect.  As  simple  as  it  may  seem, 
there  is  a  proper  and  consistent  plan  to  enable  you  to  reach 
full  success.  Before  the  patient  commences  to  inhale  he  is 
informed  of  the  fact  that  while  he  will  be  unconscious  of  pain, 
he  will  know  full  or  partially  well  any  touch  upon  his  person; 
that  the  inhalation  must  be  vigorously  kept  up  during  the 
whole  operation,  without  for  an  instant  stopping;  that  the 
more  energetically  and  steadily  he  breathes,  the  more  perfect 
the  effect.  It  is  obligatory  to  do  so,  on  account  of  its  evanes- 
cent effects,  which  demand  that  the  patient  be  pushed  by  the 
operator  over  energetic  appeals  to  '  go  on.'  It  is  very  difficult 
for  any  one  to  respire  over  one  hundred  times  to  the  minute, 
as  he  will  become  by  that  time  so  exhausted  as  not  to  be  able 
to  breathe  at  all.  For  the  next  minute  following  the  comple- 
tion of  the  operation,  the  subject  will  not  breathe  more  than 
once  or  twice.  Very  few  have  force  enough  left  to  raise  hand 
or  foot.  The  voluntary  muscles  have  nearly  all  been  subju- 
gated and  overcome  by  the  undue  effort  at  forced  inhalation 
of  one  hundred  and  seventeen,  the  normal  standard. 

"  The  heart's  action  is  not  increased  more  than  from  seventy 
(the  average)  to  eighty  and  sometimes  ninety,  but  is  much 
enfeebled,  or  throwing  a  lesser  quantity  of  blood.  The  face 
becomes  suffused,  as  in  blowing  a  fire  or  in  stooping,  which 
continues  until  the  breathing  is  suspended,  when  the  face 
becomes  paler.  (Have  not  noticed  any  purple,  as  from  as- 
phyxia by  a  deprivation  of  oxygen.)  The  vision  becomes 
darkened,  and  a  giddiness  soon  appears.  The  voluntary  mus- 
cles farthest  from  the  heart  seem  first  to  be  affected,  and  the 
feet  and  hands,  particularly  the  latter,  have  a  numbness  at 
their  extremities,  which  increases  until,  in  many  cases,  there 
is  partial  paralysis  as  far  as  the  elbow,  while  the  limbs  become 
fixed.  The  hands  are  so  thoroughly  affected,  that  when  open 
the  patient  is  powerless  to  close  them,  and  vice  versa.  There 
is  a  vacant  gaze  from  the  eyes,  and  a  looking  into  space  with- 
out blinking  of  the  eyelids  for  a  minute  or  more.  The  head 
seems  incapable  of  being  held  erect,  and  there  is   no  move- 


244  DENTAL   MEDICINE. 


ment  of  the  arms  or  legs,  as  is  usual  when  in  great  pain. 
There  is  no  disposition  on  the  part  of  the  patient  to  take  hold 
of  the  operator's  hand  or  interfere  with  the  operation."  Dr. 
Bonwell  bases  his  method  on  the  following  theory : — 

1.  Diversion  of  the  will-force  in  the  act  of  forced  respiration 
at  a  moment  when  the  heart  and  lungs  have  been  in  normal 
reciprocal  action  (twenty  respirations  to  eighty  pulsations) ; 
which  act  could  not  be  made  and  carried  up  to  one  hundred 
respirations  per  minute  without  such  concentrated  effort  that 
ordinary  pain  could  make  no  impression  upon  the  brain  while 
this  abstraction  was  kept  up. 

2.  There  is  a  specific  effect  resulting  from  enforced  respira- 
tion of  one  hundred  to  the  minute,  due  to  the  excess  of  carbonic 
acid  gas  set  free  from  the  tissues,  generated  by  this  enforced 
normal  act  of  throwing  into  the  lungs  five  times  the  normal 
amount  of  oxygen  demanded  in  one  minute,  when  the  heart 
has  not  been  around  to  exalted  action,  which  comes  from 
violent  action  in  running,  or  where  one  is  suddenly  startled ; 
which  excess  of  carbonic  acid  cannot  escape  in  the  same  ratio 
from  the  lungs,  since  the  heart  does  not  respond  to  the  pro- 
portionate over-action  of  the  lungs. 

3.  "  Hyperaemia  is  the  last  in  the  chain  of  effects ;  which  is 
due  to  the  excessive  amount  of  air  passing  into  the  lungs, 
preventing  but  little  more  than  the  normal  quantity  of  blood 
from  passing  from  the  heart  into  the  arterial  circulation,  but 
damming  it  up  in  the  brain,  as  well  as  throughout  the  capillary 
and  venous  systems  as  well  as  upon  the  heart,  the  same  as  if 
it  were  suspended  in  that  gas  outside  the  body." 

Dr.  A.  Hewson  agrees  with  Dr.  Bonwell  as  to  the  efficacy 
of  rapid  breathing  as  a  pain  obtunder,  yet  he  differs  with  them 
as  to  the  theory  or  nature  of  the  changes  in  the  different 
symptoms  brought  about  during  its  progress.  Says  Dr.  Hew- 
son: "  Every  circumstance  would  therefore  seem  to  indicate 
that  this  process  of  inducing  insensibility  to  pain  is  one  essen- 
tially of  diminished  oxidation  and  decarbonization  of  the 
blood,  and  recognizing  such  a  state  as  belonging  to  the  initia- 
tive   stage    of  all    anesthetics,  when    insensibility  to  pain  is 


ALCOHOL.  245 


positively  marked,  we  have  no  necessity  for  begging  any 
special  theory  for  this  process,  as  in  its  action  it  readily  comes 
under  the  category  of  such  agents,  and  is  thus  not  either  an 
absurdity  or  an  impossibility  from  a  scientific  point  of  view." 

ALCOHOL. 

Fornmla. — CgHgOH.  Sp.  Gr.  of  officinal  alcohol,  0.820;  of 
rectified  spirit — Spiritiis  Rectificatus,  0.838  ;  of  stronger  alcohol 
— Alcohol  Fortius,  0.817;  of  diluted  alcohol — Alcohol  Dilutuin 
(equal^iarts  of  alcohol  and  distilled  water),  0.928. 

Derivation. — Alcohol  is  obtained  from  vinous  or  fermented 
liquors  by  repeated  distillations,  and,  in  its  officinal  form,  con- 
tains about  fifteen  per  cent,  of  water.  It  is  colorless,  inflam- 
mable, wholly  vaporizable  by  heat,  and  unites  in  all  propor- 
tions with  water  and  ether.  It  frequently  contains  such  im- 
purities as  fusel  or  amylic  alcohol  (obtained  from  fermented 
grain  or  potatoes),  the  presence  of  which  can  be  detected  by 
agitating  the  alcohol  with  sulphuric  acid,  when  the  former 
becomes  colored. 

Stronger  Alcohol. — Alcohol  Fortius — Absolute  Alcohol — is 
obtained  by  agitating  the  officinal  alcohol  with  heated  carbo- 
nate of  potassium.     Sp.  Gr.,  0.794,  when  containing  no  water. 

Medical  Properties  and  Action. — All  the  different  forms  of 
alcohol,  including  brandy — Spiritus  Vini  Gallici  {the.  spirit  ob- 
tained from  fermented  grapes  by  distillation,  and  containing 
45  to  55  per  cent.,  by  volume,  of  absolute  alcohol);  whiskey — 
Spiritus  Frunienti  (the  spirit  obtained  from  fermented  grain  by 
distillation,  and  containing  from  50  to  58  per  cent.,  by  volume, 
of  absolute  alcohol);  wine — Vinum  (the  fermented  juice  of  the 
grape,  and  containing  alcohol  in  varying  proportions)  are 
powerful  diffusible  stimulants,  increasing  the  action  of  the 
heart  and  arteries,  exciting  the  nervous  and  vascular  systems, 
and  causing  a  general  exhilaration  of  spirits.  Excessive  quan- 
tities produce  the  effect  of  narcotic  poisons,  ending  in  coma 
and  death. 

The  habitual  use  of  alcoholic  drinks  causes  most  injurious 
effects  upon  the  system  generally,  and  directly  upon  the  mucous 


246  DENTAL  MEDICINE. 


coats  of  the  stomach,  deranging  and  destroying  its  functions 
and  structure,  resulting  in  dyspepsia,  followed  by  cirrhosis  of 
the  liver  and  kidneys,  loss  of  mental  and  physical  strength, 
derangement  of  the  nervous  system,  and,  at  last,  delirium 
tremens.  When  properly  administered  in  diseased  conditions, 
however,  alcoholic  preparations  are  valuable  agents. 

Therapeutic  Uses. — The  different  forms  of  alcohol  are  em- 
ployed as  stimulants  in  acute  inflammations,  such  as  pneumo- 
nia, pleurisy,  bronchitis,  pulmonary  affections  of  children,  etc., 
etc.,  and  in  rheumatic  pericarditis,  in  the  latter  stages  of  typhus 
and  typhoid  fevers,  diphtheria,  acute  neuralgia,  convulsions  of 
dentition,  tetanus,  asphyxia  from  cold,  pyaemia,  etc.,  etc.  Ex- 
ternally in  superficial  inflammation,  bruises,  sprains,  ptyalism, 
gout,  cerebral  affections,  bed- sores,  etc.,  etc.  According  to 
Bartholow,  alcohol  is  an  excellent  haemostatic  for  restaining 
oozing  from  a  large  surface,  and  an  efficient  antiseptic  dressing, 
as  it  destroys  germs,  removes  fetor,  and  stimulates  the  tissues 
to  more  healthy  growth. 

Dental  Uses. — Alcohol,  as  a  narcotic,  is  employed  to  relieve 
pain.  In  combination  with  tannic  acid  or  chloride  of  zinc,  it 
obtunds  the  sensibility  of  dentine;  as  a  styptic,  it  arrests  hem- 
orrhage from  relaxed  tissues,  coagulating  the  blood  by  its 
effect  on  albumen,  and  causing  contraction  of  the  mouths  of 
the  vessels  by  its  astringent  property.  Equal  parts  of  alcohol 
and  water  make  an  excellent  application  as  an  evaporating 
lotion,  for  the  relief  of  superficial  inflammations,  its  antiseptic 
properties  rendering  it  useful  as  a  mouth-wash  when  the  secre- 
tions are  vitiated  and  the  surfaces  of  the  mucous  membrane 
soft  and  spongy.  It  is  also  useful  for  cleaning  pulp-canals  as 
a  preparatory  treatment  to  the  use  of  the  more  active  antiseptic 
agents,  such  as  the  bichloride  of  mercury.  For  suppurating 
wounds,  it  is  a  useful  antiseptic  dressing,  as  it  destroys  germs, 
removes  fetor,  and  stimulates  the  tissues  to  a  more  healthy 
action.  It  also  favors  the  cicatrization  of  open  wounds,  coag- 
ulating the  albumen,  and  forming  an  impermeable  covering. 
In  mercurial  salivation  (mercurial  stomatitis),  it  forms  an  ex- 
cellent gargle. 


ALCOHOL. 


24/ 


For  softened  and  sensitive  dentine,  and  for  drying  cavities 
preparatory  to  filling  them,  the  stronger  or  absolute  alcohol  is 
employed.  A  simple  method  of  preparing  this  form  of  alcohol 
is  to  add  one  part  of  carbonate  of  potassa  to  four  parts  of  the 
ordinary  or  officinal  alcohol.  Owing  to  the  great  affinity  car- 
bonate of  potassa  has  for  water,  it  abstracts  the  latter  from  the 
alcohol  to  a  sufficient  degree  to  answer  all  practical  purposes. 

The  cavity  of  a  tooth  is  first  dried  with  cotton  and  bibulous 
paper,  and  then  bathed  with  the  absolute  alcohol,  which  at 
once  evaporates,  and  causes  the  almost  perfect  absorption  of 
moisture. 

Brandy  and  water  form,  in  combination,  an  excellent  lotion 
for  mercurial  and  other  forms  of  stomatitis. 


DENTAL    FORMUL/E. 


For  Obtunding  Sensitive  Dentine. 
R .    Alcohol  (absolute)  .    ,  ^  ss 
Acidi  tannici    .    .    .    .  ^ss 

Glycerini §ss.      M. 

For  Stiperjicial  Injlammations . 
R.    Alcohol, 

Aquse aa  ^ss.  M. 

SiGNA. — -To  be  applied  as  a  lotion. 

For  Obtu7tding  Sensitive  Dentine. 
R.    Alcohol  (absolute)  .    .  ^ss 
Zinci  chloridi    .    .    .    .   ^ss 

Glycerini gss.       M. 

For  Mercurial  Stomatitis. 
R .    Spts.  vini  gallici  .    .    .  i  part 

Aquae    .    .        .    .  4  to  6  parts.  M. 
SiGNA. — To  be  used  as  a  gargle. 
Antiseptic  Bath  for  Instruments. 
Dr.  a.  W.  Harlan. 

R.    Alcohol 5ij 

Hydronaphthol    .    .    .  grs.xx.    M. 
Will  not    tarnish  instruments  which 
are  dipped  in  it  and  allowed  to  dry. 
Local  AncBsthetic. 
Dr.  a.  W.  Harlan.. 

R.    Alcohol 5  parts 

Tinct.  Cannabis  indica  2  parts 


Oil  cassia I  part 

Acid  carbolic   ....  3  parts.  M. 
SiGNA. — For    injection,    or    on    cotton 
rope  around  tooth. 

Antiseptic  Mouth-  Wash. 
Gallipe  and  Malassez. 

R.    Alcohol 370  parts 

Carbolic  acid   ...     10  parts 

Thymol 5  parts 

Oil  of  peppermint   .     15  parts 
Tincture  of  arnica  .  100  parts.  M. 
This  may  be  colored  with  tincture  of 
cochineal. 

Signa. — Use  twice  a  day  and  at  same 
time  rinse  out  the  mouth  with  a  weak 
solution  of  boric  acid. 

For  Pain  After  Extraction  of  Teeth. 
Dr.  T.  B.  Welch. 


R 

.    Alcohol  (best)     . 
Chloroform  .    .    . 
Sulphuric  ether    . 
Gum  camphor  .    , 
Tinct.  opium    .    . 
Oil  cloves     .    .    . 

S.  Apply  in  the  cavity 

on  a  p 

edget 

of 

cotton. 

248  DENTAL  MEDICINE. 


For  Odontalgia, 

Dr.  J.  N.  Harris. 

R.    Alcoholis  (.best)  .    .    . 

l\ 

Chloroformi      .... 

gij 

Etheris  Sulph  .... 

IH 

Campllor^e  (gum) 

^ss 

Tinct.  opii 

iv^ 

Oleum  caryophilli    .    . 

3ss 

SiGNA. — Apply  to  cavity,  and  soon  as 

pain  ceases  fill  the  cavity 

vs'ith  cotton 

moistened   with    carbolic 

;    acid    and 

oil   of  cloves;    drop  on 

this    cotton 

sandarach    varnish,  and    allow  it  to 
remain  20  or  30  minutes. 
Local  Ancesthetic. 
Dr.  I.  Alberto  del  Solar. 
R.    Alcohol  (98  per  cent.)  fgij 

Chloroform f^i'^ 

Ether,  sulph    .    .    .    .  f^iss 

Camphor gj.        M. 

SiGNA. — Apply  to  the  gum  i  minute 
bucally  and  lingually,  first  carefully 
drying  the  surface.  Not  to  be  used 
hypodermically. 

ALOE— ALOES. 

Source. — Aloes  is  the  inspissated  juice  of  the  leaves  of  the 
Aloe  Socotrina,  and  contains  a  bitter  precipitate  known  as 
aloin,  and  also  a  volatile  oil,  to  which  its  odor  is  due.  Its  pre- 
parations are  purified  aloes — aloe  purificata  ;  watery  Extract 
of  Aloes — Extracttini  Aloes  Aqiiosuni ;  Tincture  of  Aloes — 
Tinctiira  Aloes  ;  also  a  number  of  pilular  forms,  and  a  tincture 
combined  with  myrrh — Tinctura  Aloes  et  Myrrhse,  and  wine 
of  aloes — Vinum  Aloes.  Purified  Aloes  is  in  the  form  of 
pieces  of  a  dull  or  reddish-brown  color,  very  brittle  and 
soluble  in  alcohol,  and  a  very  bitter  and  disagreeable  taste. 

Medical  Properties  and  Action. — Aloes  is  a  stomachic  tonic 
and  purgative,  being  principally  employed  for  the  latter  effect. 
In  large  doses  its  action  is  that  of  a  powerful  purgative,  and 
hence  it  is  contraindicated  in  irritable  or  inflammatory  condi- 
tions of  the  stomach.  It  stimulates  the  functions  of  the  liver, 
and  increases  the  flow  of  bile  as  well  as  the  intestinal  secre- 
tions generally.  Its  chief  effects  are  on  the  large  intestine, 
increasing  its  peristaltic  movement,  and  causing  tormina  and 
tenesmus  with  heat  and  irritation  of  the  rectum.  It  also  in- 
creases the  menstrual  flow  and  the  blood  supply  of  the  pelvic 
organs.  It  requires  some  ten  or  twelve  hours  to  produce  its 
cathartic  effects.  A  purgative  action  may  be  induced  by 
applying  it  to  an  exposed  surface.  In  moderate  laxative 
'doses  the  stools  are  not  liquid  and  but  slightly  altered  in 
character.  It  is  commonly  administered  in  small  doses  in 
combination  with  nux  vomica. 


ALUM.  249 

Therapeutic  Uses. — Aloes  is  very  efficient  in  constipation 
dependent  on  weakness  of  the  muscular  layer  of  the  large 
intestine.  It  is  also  employed  in  jaundice,  atonic  dyspepsia, 
hemorrhoids  without  active  pelvic  congestion,  amenorrhcea 
dependent  upon  anaemia,  menorrhagia  in  debilitated  condi- 
tions, gonorrhoea,  catarrh  of  uterus,  etc. 

Dose. — Of  Aloe  piirificata,  gr.  j  to  v ;  extractuvi  aloes  aqiio- 
sian,  gr.  ss  to  iij ;  Tinctura  Aloes,  foss  to  ij  ;  Tinctura  Aloes 
Myrrhae,  5ss  to  3ij ;    Vmiivi  Aloes  5j  to  oSS. 

ALUMEN— ALUM. 

Formula. — Common  potash  alum  :  Al2(S04)3,  K2S0^24H20. 
Ammonium  Alum  :  Al2(NHj2(S04)i,  24H2O. 

Source. — It  is  found  native  in  Italy,  in  the  neighborhood  of 
volcanoes,  and  is  the  mineral  from  which  the  metal  aluminum 
is  obtained. 

Derivation. — Alum  is  also  obtained  from  aluminous  slate, 
shale  or  schist,  by  the  process  of  roasting  and  exposure  to 
the  air. 

Alunj  is  a  white,  slightly  efflorescent  salt,  which  crystallizes 
in  regular  octahedrons.  It  possesses  an  astringent,  acid,  and 
sweetish  taste.  It  is  insoluble  in  alcohol,  but  dissolves  in 
from  fourteen  to  fifteen  times  its  weight  in  cold,  and  three- 
fourths  of  its  weight  of  boiling  water. 

Medical  Properties  and  Action. — Alum  is  astringent  and 
styptic,  and  is  employed  both  externally  and  internally. 
When  taken  internally,  it  is  absorbed  into  the  system,  and  has 
been  detected  in  the  liver,  spleen  and  urine.  Excessive  doses 
cause  vomiting,  griping,  purging,  and  inflammation  of  the 
gastroenteric  mucous  membrane.  Powdered  alum,  in  doses 
of  a  teaspoonful,  is  an  efficient  emetic.  It  coagulates  albumen 
and  causes  an  abundant  flow  of  saliva,  coagulating  the  albu- 
men of  the  saliva  and  buccal  mucus  in  whitish,  membranous 
flakes. 

Its  astringent  influence  is  chiefly  upon  mucous  surfaces. 
Applied  locally  to  relaxed  or  bleeding  parts,  it  corrugates  the 
surrounding  tissues  and  causes  contraction  of  the  capillarie.s, 
and,  in  this  manner,  acts  as  an  astringent. 


250  DENTAL  MEDICINE. 


Therapeutic  Uses. — Alum  is  internally  administered  in  diar- 
rhoea, chronic  dysentery,  colica  pictonum,  catarrh  of  the  stom- 
ach, etc.  Externally  it  is  applied  in  ulcerated  and  relaxed 
throat  affections,  ptyalism,  gonorrhoea  and  gleet,  uterine  hem- 
orrhage, morbid  growths,  haematuria,  ophthalmia,  chronic 
whooping  cough,  chronic  skin  diseases,  chilblains,  ulcers, 
hospital  gangrene,  etc.,  etc. 

Dose. — Of  alum,  gr.  x  to  9j  or  3ij,  in  powder,  or  solution 
in  water,  or  in  some  simple  infusion. 

Ammonia  Alum. — Sulphate  of  alumina  and  ammonia — 
AlzivziftcE  et  Ai]inioni(B  Sulphas — is  prepared  by  adding  sul- 
phate of  ammonia  to  a  solution  of  sulphate  of  alumina. 

Dried  Alum. — Aliimen  Exsiccatmn  (alum  deprived  of  its 
water  of  crystallization  by  heat) — is  employed  externally  as  a 
mild  escharotic,  to  destroy  exuberant  granulations,  etc. 

Dental  Uses. — Alum  is  employed  in  dental  practice  as  a 
styptic  in  alveolar  hemorrhage ;  as  a  gargle  in  stomatitis, 
ulceration,  and  sponginess  of  the  gums,  morbid  or  fungous 
growth  of  gums,  dental  pulp,  etc.,  superficial  hemorrhage  from 
the  mucous  membrane  of  the  mouth,  ulcers  of  the  mouth, 
cancrum  oris,  odontalgia,  etc.,  etc.  In  congested  conditions 
of  the  mucous  membrane  of  the  mouth  and  throat,  alum  gar- 
gles afford  great  relief  Powdered  alum  added  to  liquor 
sodae  chlorinatae  (Labarraque's  Solution),  is  an  excellent 
bleaching  application  for  discolored  necrosed  teeth. 

The  habitual  use  of  alum  as  an  ingredient  of  a  dentifrice  is 
injurious  to  the  teeth,  on  account  of  the  sulphuric  acid  it 
contains. 

Potash  alum — Aliuninii  et  Potassii  Sulphas — the  alum  of 
commerce  (which  has  been  superseded  by  ammonia  alum),  will 
render  plaster  casts  hard,  when  they  are  boiled  in  a  strong 
solution  for  half  an  hour. 

DENTAL  FORMULA. 
For  Odontalgia.  For  Inflamed  and  Ulcerated  Mucous 

R.    Pulveris  alurainis    .    .   ^ij  Membrane  and  Gums. 

^theris    nitrici     .    .    .   ^vij  R.    Pulveris  aluminis     .    .  gr.lxxx 

SiGNA. — To  be  applied  on  a  pellet  of  Aquge  destillatse  .    .    .  f^x.       M. 

cotton.  SiGNA. — To    be    applied    as   a   mild, 

astringent  gargle. 


ACETATE   OF   ALUMINA.  251 


For  Ulceration  of  the  Gums  and  Mticotis  For   Ulcerated  and  Spongy   Gums. 

Membrane  of  the  Month.  ^      Aluminis ^j 

R.    Aluminis "2^]  Vini Oj 

Zinci   sulphatis     .    .    .   gss  Tinct.  cinchonse  .    .    .   5ss 

Sodii  borat gr.iv  Tinct.  myrrhse     .    .    .   3  ij 

Aquae  rosce ^viij.    M.  Mel.  rosce 5!].        M. 

SiGNA. — To  be  applied  as  a  lotion.  SiGNA. — To  be  used  as  a  gargle. 

For  Inflatiimation  and  Ulceration  of  the  Month  and  Throat. 

R.         Infus.  lini §xv 

Tinct.  kino ^j 

Aluminis ^ij  M. 

SiGNA. — To  be  applied  as  a  gargle. 

ALUMINA   ACETAS— ACETATE   OF   ALUMINA. 

Formula.— K\lOYi).lQ^p.^^. 

Derivation. — The  salt,  Acetate  of  Alumina,  is  obtained  by 
the  direct  combination  of  hydrated  alumina  with  acetic  acid, 
or  by  reaction  between  sulphate  of  alumina  and  acetate  of 
lead.  The  solution,  when  properly  prepared,  is  a  clear  fluid, 
of  a  sharp,  sweetish,  astringent  taste,  and  a  distinct  odor  of 
acetic  acid.  When  it  is  evaporated,  there  is  deposited  light, 
fragile,  glossy  scales,  which  are  perfectly  soluble  in  water,  and 
not  readily  affected  by  the  atmosphere. 

Medical  Properties  and  Action. — It  is  disinfectant  and  anti- 
septic. In  maximum  doses  it  produces  an  unpleasant  sensa- 
tion of  warmth  and  fullness  in  the  stomach,  and  at  the  same 
time,  vertigo  and  confusion  of  the  senses,  which  may  continue 
for  several  hours. 

Therapeutic  Uses. — Acetate  of  alumina  is  rarely  employed 
internally,  and  only  for  zymotic  and  contagious  diseases.  It 
is  generally  used  externally,  and  is  a  very  effectual  remedy  in 
the  treatment  of  wounds,  preventing  pyemia  in  suppurating 
wounds  and  ulcers.  It  is  also  applied  in  parasitic  skin  affec- 
tions, as  an  injection  in  gonorrhoea,  and  for  the  destruction  of 
animalculae  in  putrescent  fluids.  As  a  surgical  dressing,  it  is 
used  by  keeping  the  wound  saturated  with  a  solution  of  mod- 
erate strength,  or  by  irrigation.  A  concentrated  solution  will 
preserve  anatomical  subjects  for  a  considerable  time. 

Dose. — Of  acetate  of  alumina,  gtt.  xx  to  gtt.  60  of  the 
solution. 


252  DENTAL  MEDICINE. 


Dental  Uses. — Acetate  of  alumina  is  useful  in  dental  practice, 
as  an  antiseptic  and  disinfectant  in  cancrum  oris,  ulcers  of  the 
mouth,  suppurating  wounds  of  mucous  membrane,  pyorrhoea 
alveolaris,  alveolar  abscess,  etc.  A  very  weak  solution  has 
been  employed  as  a  mouth-wash  for  offensive  breath  depending 
on  scrofulous  ulcerations,  aphthae,  caries  of  the  teeth,  or  the 
wearing  of  artificial  teeth. 

SULPHITE  OF  ALUMINIUM— ALUMINII  SULPHIS. 
The  sulphite  of  aluminium  is  a  new  antiseptic,  being  a  sul- 
phurous salt  of  aluminium  ;  that  metal  uniting  with  acids  to 
form  salts  in  the  proportion  of  two  molecular  equivalents  of 
the  base  and  three  of  the  acid.  The  persulphite  may  be  made 
by  adding  sulphurous  acid  to  the  undried  sesquisulphite  to 
solution  and  crystallizing  without  heat;  or  by  precipitating  the 
persulphite  from  solution  with  alcohol,  filtering  or  decanting, 
washing  the  precipitate  with  alcohol  and  drying  on  bibulous 
paper.  The  sulphurous  salts  of  aluminium  are  the  best  repre- 
sentatives of  its  antiseptic,  therapeutic  properties,  two  being  pro- 
duced— the  sesquisulphite  and  the  persulphite ;  the  former  being 
insoluble  in  water,  while  the  sulphite  is  soluble.  Three  hundred 
times  as  much  of  the  sesquisulphite  of  aluminium  can  be  admin- 
istered with  safety  as  of  the  bichloride  of  mercury,  and  while  the 
latter  is  two  and  a  half  times  as  active  as  the  aluminium  salt 
in  equal  quantity,  the  difference  in  dose  permissible  favors  the 
relative  efficiency  of  the  latter;  and  the  same  relations  exist  in 
the  topical  use  of  these  two  agents.  The  insoluble  sesquisul- 
phite may  be  made  by  taking  the  theoretical  quantities  of 
potassic  alum  and  sulphite  of  sodium  and  mixing  their  solu- 
tions in  water ;  the  precipitate  to  be  washed  and  carefully  dried. 
The  proportion  is  ten  parts  of  alum  and  eight  of  sodium  sul- 
phite. These  aluminium  salts  are  applicable  to  almost  every 
conceivable  condition  where  an  antiferment  is  indicated. 

AMMONIUM— AMMONIA. 
Formula. — N  H^. 

Ammonia,    often    called    ammoniacal,    or  ammonia  gas,  is 

colorless  and  readily  soluble  in  water,  and  forms  a  number  of 


AMMONIA.  253 


volatile  stimulants,  such  as  Aqtia  ammonicB — ammonia  water, 
which  is  the  stronger  water  of  ammonia  diluted  with  two 
parts  of  water ;  Aqua  aninionia;  fortior — stronger  water  of 
ammonia,  is  made  by  passing  ammonia  gas  into  water  to  make 
its  specific  gravity,  0.900  at  59°  F. ;  Spiritiis  animonicB — which 
is  a  ten  per  cent,  solution  of  ammonia  gas  in  alcohol ;  Spiritus 
avimonice  aromaticiis,  which  is  an  alcoholic  solution  of  carbon- 
ate of  ammonium,  to  which  are  added  oils  of  lemon,  nutmeg 
and  lavender.  (See  also  muriate  of  ammonia,  sal  ammoniac, 
carbonate  of  ammonium,  solution  of  acetate  of  ammonia,  spirit 
of  mindererus,  chloride  of  ammonium,  and  valerianate  of 
ammonium.) 

Medical  Properties  and  Action. — Ammonia  gas  is  very  alka- 
line, and  an  irritant  to  mucous  surfaces.  Inhaled,  it  causes  an 
ov^erpowing  sense  of  suffocation  and  spasm  of  the  glottis,  and 
when  prolonged,  violent  inflammation  of  the  air-passages.  Solu- 
tion of  ammonia  when  swallowed  causes  destructive  inflamma- 
tion of  the  mucous  membrane,  extending  to  the  stomach.  The 
long-continued  use  of  ammonia  interferes  with  digestion  by 
neutralizing  the  gastric  juice,  and  by  increased  waste  of  tissue 
causes  pallor,  emaciation,  and  feebleness.  In  the  blood  it 
injures  the  red  blood  globules,  and  thus  affects  the  nutrition 
of  the  body,  being  largely  converted  into  urea.  The  prepara- 
tions of  ammonia  are  stimulant  expectorants. 

TJierapeutic  Uses. — Aqua  ammonia  is  administered  by  in- 
halation in  syncope  and  shock,  and  as  a  counter-irritant;  for 
which  purpose  ammonia  liniment  is  also  employed.  The  in- 
cautious inhalation  of  ammonia  may  cause  inflammation  of 
the  fauces  and  glottis,  but  when  cautiously  employed  some- 
times gives  relief  to  acute  catarrh  and  hay  asthma.  The 
diluted  aqua  ammonia  will  relieve  the  pain  of  stings  of  insects, 
and  the  strong  aqua  ammonia  is  an  antidote,  when  at  once 
applied,  to  the  bite  of  venomous  snakes,  and  of  rabid  animals. 
The  aromatic  spirits  of  ammonia  is  useful  in  acidity  of 
stomach,  gaseous  eructations  and  abdominal  distension  ;  also 
in  sick  headache  and  migraine;  but  the  bromides  are  more 
effective  in  the  latter  affection.     Ammonia  salts  stimulate  the 


254  DENTAL   MEDICINE. 


liver  and  increase  the  secretions  of  the  kidneys  and  intestinal 
mucous  glands  and  the  action  of  the  heart,  hence  are  frequently- 
used  in  adynamic  states,  constipation,  coated  tongue  and  scanty 
urine.  The  preparations  of  ammonia  for  internal  use  correct 
obstinate  vomiting  when  the  irritating  substances  are  removed, 
and  the  matters  vomited  are  acid. 

Dose. — Of  Aqua  Ammoniae,  ITLv  to  5ss,  much  diluted ;  of 
Spiritus  Ammoniae,  TTLx  to  f5j,  greatly  diluted;  of  Spiritus 
Ammoniae  Aromaticus,  fjss  to  fjij. 

Dental  Uses. — Ammonia  is  used  as  a  stimulant  in  danger- 
ous narcosis ;  to  prevent  syncope  or  severe  shock  ;  in  facial 
neuralgia,  especially  the  chloride,  and  in  periodontitis  when  it 
is  combined  with  aconite  and  opium.  Aqua  ammonia  is 
locally  applied  as  a  counter-irritant  to  the  gums  in  acute  inflam- 
mation of  the  peridental  membrane.  (See  Acetate,  Carbonate, 
Valerianate  and  Chloride  of  Ammonium). 

LIQUOR    AMMONII    ACETATIS— SOLUTION    OF   ACETATE   OF 
AMMONIA. 

SPIRIT   OF   MINDERERUS. 

Formula. — NH4C2H3O2. 

Derivation. — Spirit  of  Mindererus  is  obtained  by  saturating 
diluted  acetic  acid  with  carbonate  of  ammonia,  being  a  solu- 
tion of  the  acetate  of  ammonia. 

It  is  a  colorless  liquid,  with  a  saline  taste,  and  requires  to 
be  freshly  made  when  about  to  be  used. 

Medical  Properties  and  Action. — It  is  refrigerant,  diaphoretic, 
and  diuretic,  and  its  action  can  be  greatly  increased  by  com- 
bination with  other  remedies.  Few  medicines  are  in  more 
general  use. 

Therapeutic  Uses. — Spirit  of  mindererus  is  employed  in  the 
treatment  of  febrile  and  inflammatory  affections,  and  exanthe- 
mata, sick  headache,  catarrh  and  influenza,  etc.,  etc.  Externally 
it  is  used  as  a  lotion  to  sprains,  bruises,  glandular  enlarge- 
ments, etc. 

Dose. — Of  spirit  of  mindererus,  f5j  to  foj. 

Dental   Uses. — A    lotion   composed  of   one  part  to    ten  of 


CARBONATE  OF  AMMONIUM.  255 

water  is  a  serviceable  application  in  inflamed  conditions  of 
mucous  membrane.  Internally  administered  as  a  refrigerant, 
it  is  useful  in  acute  periosteal  inflammation,  inflammation  of 
the  dental  pulp — pulpitis,  and  is  a  diaphoretic  and  refrigerant 
in  periodontitis,  when  it  may  be  combined  with  either  aconite 
or  opium,  or  both. 

AMMONII    CARBONAS  -  CARBONATE   OF   AMMONIUM. 

Derivation. — Carbonate  of  Ammonium  is  a  sesquicarbonate, 
and  is  obtained  by  subliming  a  mixture  of  chloride  of  ammo- 
nium and  chalk.  It  is  in  the  form  of  white,  translucent 
masses,  with  a  pungent,  ammoniacal  odor,  and  an  acrid, 
alkaline  taste.  It  is  soluble  in  water,  and  on  exposure  to 
the  air  it  becomes  opaque  and  falls  into  powder,  losing  its 
ammonia. 

Medical  Properties  a?id  Action. — It  is  antacid,  stimulant,  dia- 
phoretic and  expectorant,  and  it  is  considered  to  be  especially 
useful  in  cases  where  the  vital  powers  are  greatly  depressed. 
In  large  doses  it  causes  colic,  convulsions  and  great  dis- 
turbance of  the  nervous  system,  and  when  long  continued,  an 
annoying  itching  of  the  scalp,  and  skin  over  the  surface  of  the 
body.  It  has  a  tendency  to  fluidify  the  blood.  Internally,  as 
a  diffusible  stimulant,  it  is  preferred  to   solution  of  ammonia. 

Therapeutic  Uses. — It  is  internally  administered  in  diabetes, 
scrofula  with  languid  circulation,  asthma,  pneumonia,  croup, 
chorea,  diseases  of  the  skin,  puerperal  insanity,  mercurial 
erethism,  drunkenness,  etc.,  etc. 

Externally  it  is  employed  as  a  volatile  or  smelling  salts,  in 
syncope,  hysteria,  and  asphyxia. 

Dose. — Of  carbonate  of  ammonium,  gr.  v.  to  gr.  x,  in  pill  or 
in  solution  with  gum  and  sugar. 

Dental  Uses. — It  is  a  useful  internal  remedy  in  cancrum  oris, 
in  doses  of  gr,  v,  gradually  increased  to  gr.  x,  every  two  or 
three  hours,  using  strong  nitric  acid  as  a  local  application.  It 
is  also  a  very  useful  remedy  in  mercurial  erethism,  in  conjunc- 
tion with  camphor  and  other  stimulants  ;  also  as  a  stimulant 
in  dangerous  narcosis  from  anaesthetic  agents. 


256  DENTAL   MEDICINE. 


AMMONII  VALERIANAS— VALERIANATE  OF  AMMONIUM. 

Formula. — NH4C5Hg02. 

Derivation.^ — Valerianate  of  ammonium  is  obtained  by  com- 
bining valerianic  acid  with  a  strong  solution  of  ammonia  and 
evaporating  to  a  syrupy  consistence  ;  it  is  also  obtained  by  sub- 
jecting the  monohydrated  acid  to  the  action  of  dry,  gaseous 
ammonia.  It  is  in  the  form  of  a  white  salt,  in  quadrangular 
plates,  with  the  odor  of  valerianic  acid,  and  a  sharp,  sweetish 
taste.     It  is  soluble  in  water  and  alcohol. 

Medical  Properties  and  Action. — It  is  a  stimulant,  nervine, 
and  antispasmodic. 

Therapeutic  Uses. — It  is  employed  in  neuralgia,  nervous 
headache,  hysteria,  epilepsy,  chorea,  etc.,  etc.,  especially  for 
females. 

Dose. — Of  valerianate  of  ammonium,  gr.  ij.to  gr.  viij,  in  pill 
or  elixir,  with  aromatics  (valeranate  of  ammonium  3j,  fluid 
extract  of  vanilla  f^ss,  tincture  of  cardamom  f5vj,  curacoa 
f3ij,  water  f5iv — Misce.  Dose,  a  teaspoonful  three  times  a 
day). 

Dental  Uses. — It  is  internally  administered  for  neuralgia. 

AMMONII  CHLORIDUM— CHLORIDE  OF  AMMONIUM. 
MURIATE  OF  AMMONIA— HYDROCHLORATE  OF  AMMONIA— SAL  AMMONIAC. 

Formula. — NH^Cl. 

Derivation. — Chloride  of  Ammonium  is  obtained  by  neu- 
tralizing hydrochloric  acid  with  ammonia,  and  evaporating  to 
dryness.  It  is  in  the  form  of  a  snow-white,  crystalline  powder, 
soluble  in  two  and  a  half  parts  of  cold  water,  and  sparingly 
soluble  in  alcohol.     It  has  a  pungent,  saline  taste. 

Medical  Properties  and  Action. — In  large  doses  it  is  an  irritant 
poison,  with  a  purging  action  ;  but  in  small  doses  it  is  a  pow- 
erful resolvent  alterative  ;  it  is  also  refrigerant  and  anodyne. 
Its  action  upon  the  system  closely  resembles  that  of  mercury 
as  an  alterative. 

Externally  it  is  used  as  a  discutient  application,  and  as  a  cold 
lotion  in  fevers,  hernia,  etc. 

TJierapeiitic  Uses. — It  is  employed  internally  in  amenorrhoea. 


AMYLENE.  257 


rheumatic  affections,  chronic  bronchitis,  pneumonia,  dropsical 
affections,  hemmorhages,  whooping  cough  and  myalgia.  Ex- 
ternally in  abcesses  of  the  mamma,  skin  diseases,  ecchymosis 
of  the  eye,  hydrocele,  senile  gangrene,  gonorrhoea,  leucor- 
rhoea,  etc. 

Dose. — Of  chloride  of  ammonium,  gr.  v-xxx,  every  two  or 
three  hours,  in  powder  or  mucilage. 

Dental  Uses. — It  is  employed  in  facial  neuralgia,  in  doses  of 
5ss,  repeated  four  times  daily.  Externally  it  is  used  as  an 
application  to  indolent  ulcers,  for  its  stimulating  effect.  As  a 
gargle,  it  is  employed  in  the  strength  of  oSS  to  gxij  of  water. 
It  is  also  applied  to  cancerous  tumors,  and  has  been  used  to 
restore  zinc  which  has  become  deteriorated  from  long  use  in 
laboratory  work.  Chloride  of  ammonium  (sal  ammoniac)  is 
also  used  as  a  flux,  in  refining  gold  for  laboratory  use. 

AMYLENE. 
Formula. — CsHk,. 

Derivation.- — Amylene  is  obtained  by  distilling  amylic  alcohol 
with  chloride  of  zinc.      It  is  a  colorless,  very  mobile  liquid, . 
with  a  boiling  point  of  102°,  and  the  density  of  its  vapor  2.45. 
It  has  a  very  peculiar  and  disagreeable  smell. 

Medical  Properties  and  Action. — Amylene  was  introduced  as 
an  anaesthetic  in  1856,  by  the  late  Dr.  Snow,  who  regarded  it 
as  possessing  the  following  advantages  :  the  safety  of  ether, 
absence  of  pungency  and  irritating  property,  readiness  with 
which  the  absence  of  pain  is  obtained,  with  less  coma  than 
with  chloroform  or  ether,  the  speedy  recovery  from  its  effects, 
less  nauseating,  and  less  headache  and  rigidity  and  struggling 
than  in  the  case  of  ether  or  chloroform.  Others,  however, 
have  not  been  so  much  impressed  with  this  anaesthetic  agent  as 
was  Dr.  Snow;  hence,  it  has  not  been  regarded  with  the  same 
favor  as  other  agents  of  this  class.  An  extreme  quantity  being 
required  to  produce  complete  insensibility  to  pain,  its  opera- 
tion is  considered  to  be  dangerous. 

Therapeutic  Use. — As  an  anaesthetic. 

Hydrate  of  Amylene  is  a  tertiary  alcohol   first  prepared  by 

Wurtz.     It  is  a  colorless,  watery-looking  fluid,  with  a  sharp 
17 


258  DENTAL   MEDICINE. 


taste  and  smell,  and  is  soluble  in  eight  times  its  volume  of  al- 
cohol. It  is  generally  regarded  as  a  safe  and  reliable  narcotic 
and  hypnotic,  sleep  being  produced  in  from  fifteen  to  forty- 
five  minutes,  and  sometimes  almost  instantly.  When  large 
doses  are  given,  sleep  may  be  induced  in  five  or  eight  minutes, 
and  as  a  rule  its  actions  are  prompt  and  safe.  Contra-indi- 
cations  of  the  drug  have  not  yet  been  observed,  but  in  cases 
of  severe  gastric  troubles  and  ulcerations  of  the  pharynx, 
it  should  be  given  per  anus.  Its  action  may  be  briefly 
summed  up  as  follows  : 

1.  Hydrate  of  amylene  is  a  hypnotic  whose  action  can  be 
confidently  relied  upon  when  sufficiently  large  doses  are  given. 
Experiments  have  shown  that  it  is  not  so  strong  as  chloral, 
yet  stronger  than  paraldehyde. 

2.  Hydrate  of  amylene  also  acts  upon  persons  who  are  ac- 
customed to  the  use  of  hypnotics,  although  the  dose  employed 
in  such  cases  must  be  comparatively  large. 

3.  Sleep  occurs  soon  after  the  administration  of  the  drug, 
and  is  not  preceded  by  any  period  of  excitement.  The  sleep 
produced  is  light  or  heavy,  according  to  the  dose  given  ;  yet 
it  is  always  easy  to  awaken  the  patient.  Upon  waking,  the 
patient  is  perfectly  sensible  and  bright,  but  if  not  disturbed 
further  will  at  once  fall  asleep  again. 

4.  Sleep  lasts  from  two  to  three  hours  if  small  doses  have 
been  given,  or  from  six  to  eight  hours  under  the  influence  of 
larger  doses. 

5.  The  awaking  is  similar  to  that  from  natural  sleep.  The 
patient  feels  rested  and  strengthened.  No  headache  or  weak- 
ness was  ever  observed. 

6.  The  respiration  remains  unchanged. 

7.  The  change  in  the  pulse's  frequency  and  in  the  pressure 
of  blood  is  no  more  than  that  which  accompanies  natural  sleep. 

8.  The  patients  were  never  observed  to  wake  up  with  a  bad 
taste  in  their  mouths  and  complaining  of  a  disagreeable 
smell,  symptoms  which  nearly  always  follow  the  use  of  paral- 
dehyde. 

9.  Whether  or  not  a  habit  and  tolerance  for  the  drug  may 


NITRITE  OF  AMYL.  259 


be  formed  remains  yet  to  be  seen.  As  yet,  even  when  the  dose 
has  been  used  continually,  an  increase  of  dose  was  never  found 
necessary. 

Dose. — Of  hydrate  of  amylene  grs.  xii  to  grs.  xxxvii.  It 
may  be  administered  in  gelatin  capsules  containing  15^  grains 
each,  or  in  the  fluid  form  mixed  with  claret  and  water,  or 
raspberry  syrup. 

AMYL  NITRIS— NITRITE  OF  AMYL. 

Formula. — C5H11NO2.     Sp.  gr.,  0.877. 

Derivation. — Nitrite  of  Amyl  is  obtained  by  heating  one 
part  of  strong  nitric  acid  with  two  parts  of  rectified  fusel  oil, 
until  reaction  commences,  when  the  heat  is  withdrawn,  and 
afterward  re-applied.  The  distilled  portion  obtained  below 
212°  F.  is  rectified  by  means  of  carbonate  of  potassium,  and 
that  portion  only  distilling  between  200°  and  206°  F.  is  re- 
served, being  a  nitrite  of  oxide  of  amyl.  It  is  a  yellowish  or 
amber-colored  liquid,  somewhat  oily,  very  volatile  and  inflam- 
mable, and  boils  at  182°  F.  It  has  an  odor  like  that  of 
ripe  pears,  and  belongs  to  the  class  of  compound  ethers. 

Medical  Properties  and  Action. —  It  is  used  by  inhalation, 
causing  an  accelerated  action  of  the  heart,  sudden  flushing  of 
the  face,  dilatation  of  the  arteries,  paralysis  of  the  action  of 
the  smaller  arteries,  a  sense  of  great  fullness  of  the  brain,  a 
lowering  of  the  blood  pressure  and  temperature,  and  com- 
plete resolution  of  the  muscular  system.  The  vapor  of  nitrite 
of  amyl,  when  applied  directly  to  the  muscular  or  nervous 
tissues,  arrests  their  functional  activity,  and,  circulating  in  the 
blood,  appears  to  act  most  on  the  vaso-motor  system  and 
unstriped  muscular  fibre.  It  affects  respiration  and  the  com- 
position of  the  blood,  producing  headache,  which  is  often  pro- 
longed. 

Therapeutic  Uses: — Being  a  powerful  stimulant  to  the  heart, 
it  is  an  antidote  to  chloroform  and  cocaine.  A  case  is  men- 
tioned in  the  British  Medical  Journal,  where,  during  chloroform 
narcosis,  respiration  ceased,  and  artificial  respiration  failed  to 
restore  the  patient.     Some  nitrite  of  amyl  was  then  poured  on 


260  DENTAL  MEDICINE. 


lint,  and  held  to  the  patient's  nostrils.  In  ten  seconds  there 
was  a  flushing  of  the  face,  the  pulse  was  again  felt,  and  respi- 
ration was  restored. 

When  from  two  to  five  minims  are  poured  on  lint  and  ap- 
plied to  the  nostrils,  the  heart's  action  will  be  accelerated,  a 
sudden  flushing  of  the  face  takes  place,  dilatation  of  the  arte- 
ries results,  also  a  fall  in  the  blood  pressure  and  a  lowering  of 
the  temperature,  and  complete  muscular  relaxation.  As  a 
remedy  for  chloroform  narcosis,  it  is  supposed  to  antagonize 
cerebral  anaemia  by  causing  capillary  dilatation  and  thus  pro- 
moting the  inflow  of  blood  to  the  brain. 

By  inhalation,  for  relieving  the  pain  of  angina  pectoris,  and 
preventing  epileptic  seizures  ;  also  used  in  asthma,  strychnia 
poisoning,  hydrophobia,  tetanus,  epileptic  attacks,  and  in  many 
other  convulsive  or  spasmodic  diseases. 

Dose. — Of  nitrite  of  amyl,  TTLij  to  TTLv,  by  inhalation ;  not 
more  than  TTLiij  should  be  administered,  unless  the  patient 
has  been  accustomed  to  its  use. 

Dental  Uses. — As  an  antidote  for  chloroform  narcosis,  for 

the  relief  of  epileptic  attacks  during  the  extraction  of  teeth, 

for  relieving  the  pain  of  neuralgia  of  the  fifth  pair  of  nerves, 

and  for  restoration  from   .syncope.     As  nitrite   of  amyl  is  a 

powerful  and   dangerous  agent,  care  must  be  observed  in  its 

use,  and  but  small   doses   applied  at  first,  as  some  patients, 

especially  the  weak   and  nervous,  are  very  susceptible  to  its 

influence. 

ANTHEMIS— CHAMOMILE. 

Source. — The  flowers  of  the  Anthemis  Nobilis.  A  German 
variety  is  known  as  Alatricaria,  which  is  similar  to  Anthemis 
in  its  effects.  The  herb  chamomile  has  a  fragrant  odor  and  a 
bitter,  aromatic  taste.  A  volatile  acid  is  obtained  from  the 
flowers,  which  is  similar,  if  not  identical,  with  valerianic  acid. 

Medical  Properties  and  Therapeutic  Uses. — Chamomile  is  a 
mild  tonic  in  small  doses,  but  in  large  doses  may  act  as  an 
emetic.  It  is  used  in  the  form  of  a  cold  infusion  in  enfeebled 
digestion,  flatulent  colic  and  infantile  disorders  connected  with 
digestive  derangement.     It  is  also  employed  in  the  form  of 


ANILINE.  261 


infusions  prepared  with  hot  water  and  vinegar,  for  the  relief  of 
pain  of  boils,  abscesses,  etc.  When  employed  for  the  relief  of 
odontalgia  in  the  form  of  fomentations  to  the  face,  there  is 
danger  of  the  abscess  pointing  externally  ;  it  is  also  applied 
to  flabby,  ill-conditioned  ulcers  as  a  gentle  excitant.  The 
tepid  infusion  will  promote  the  operation  of  emetics. 

Dose. — Of  the  powder  as  a  tonic,  oss  to  5j.  It  is  generally 
employed  in  the  form  of  infusion. 

ANILINE, 

Formula. — CgN  H^. 

Derivation. — Aniline  is  an  alkaloid  obtained  by  the  destruc- 
tive distillation  of  various  organic  substances.  It  is  a  volatile, 
colorless,  pungent  liquid  generally  derived  from  coal  tar. 

Medical  Properties  and  Therapeutic  Uses. — Professor  Stilling 
claims  that  wounds  and  suppurating  ulcers,  especially  those 
in  and  about  the  eye,  treated  with  aniline  may  be  entirely 
sterilized  by  the  solution  penetrating  everywhere,  and  the 
suppuration  be  entirely  arrested.  When  the  pus  is  deep  in 
the  tissue,  injections  of  aniline  solution  should  be  employed, 
or  the  introduction  of  aniline  crayons,  or  bathing  with  con- 
centrated solutions.  In  many  cases  application  of  a  powdered 
aniline  is  very  efficacious.  These  aniline  colors  are  destitute 
of  all  toxic  action ;  they  are  very  diffusible,  and  they  do  not 
coagulate  albumen.  These  colors  are,  however,  soon  decom- 
posed by  exposure  to  light,  and  they  should  therefore  be  pro- 
tected. 

Dental  Uses. — But  two  of  the  basic  aniline  coloring-matters, 
methyl-violet  (pyoktanin)  and  viethylene-blue,  have  been  tested  as 
antiseptics,  and  although  highly  recommended  by  Prof  Stilling, 
they  have  not,  in  the  experiments  of  Prof.  W.  D.  Miller,  when 
employed  as  antiseptics  in  the  treatment  of  the  dental  pulp, 
given  satisfactory  results,  as  they  did  not  appear  to  penetrate 
the  pulps  to  a  depth  of  more  than  a  quarter  of  an  inch,  and 
showed  no  preservative  action.     (See  Pyoktanin.) 


262  DENTAL  MEDICINE. 


ANTIKAMNIA. 

Antikamnia  is  a  combination  of  coal  tar  derivatives  into 
which  the  amnines  have  entered,  forming  various  amido  com- 
pounds, of  which  the  general  group  formula  is  CnH2n-6.  It 
has  as  its  base  the  derivatives  of  the  amido-benzoles  so  com- 
bined, it  is  claimed,  as  to  obviate  the  bad  effects  caused  by- 
many  of  this  series  of  organic  bodies  when  administered  alone. 
It  is  in  the  form  of  a  white  powder  with  a  pungent  taste. 

Medical  Propei'ties  and  Therapeutic  Uses. — Antikamnia  is 
an  antipyretic,  analgesic  and  anodyne,  and  causes  a  quieting 
influence  upon  the  nervous  system,  inducing  and  promoting 
sleep.  It  is  employed  in  neuralgia,  myalgia,  sciatica,  acute 
rheumatism,  hemicrania,  typhoid  fever;  also  headache  and 
other  neuroses  due  to  irregularities  of  menstruation ;  also  in 
asthma,  hay  fever,  influenza,  la  grippe  and  allied  affections. 

Dose. — Grs.  iij  to  grs.  x,  every  three  or  four  hours. 

To  Prevent  the  Disturbance  of  the  Ner-  Syr.  Aurantii  Flor.      .  aa^iv.   M. 

vous  Systejft  which  Accompanies  the      SiGNA. — Tablespoonful   every   3  or   4 
Administration  of  Quinine.  hours. 

U .    Antikamnia      .    .    .    .   3  ss  Anodyjie  and  Analgesic. 

Sulphate  of  quinine    .   ^ij.  M. 

Make  xii  capsules,  i   every  2  or  4      B-    Antikamnia     .... 

hours  as  may  be  indicated.  Q^i'^i^  sulph aa  ^ss 

Pulv.  Dover!    ....  grs.viii 

Analgesic  and  Anodyne.  Soda  bicarb grs.xij 

R.    Antikamnia gij  Ft.  viij  capsules. 

Spts.  Yin.  Gall    .    .    .  Dose. — One  capsule  every  4  hours. 

ANTIPYRINE— DIMETHYLOXYQUINIZINE. 

Formula. — C11H12N2O. 

Antipyrine  is  in  the  form  of  whitish  or  grayish-white  crys- 
talline powder,  slightly  bitter  sweetish  taste,  and  soluble  in 
water.     It  combines  with  acids  to  form  salts. 

Medical  Properties  and  Therapeutic  Uses. — Antipyrine  is  a 
powerful  antipyretic,  local  anaesthetic,  disinfectant,  haemostatic 
and  stomachic  tonic,  and  acts  as  an  antiseptic  in  preventing 
fermentative  changes  in  the  intestines.  It  is  also  slightly  hyp- 
notic.    It  stimulates  the  secretions  and  readily  diffuses  into 


ANTIPYRINE.  263 


the  blood.  It  first  stimulates  and  then  paralyzes  the  nerve- 
centres,  dilates  the  cutaneous  vessels,  and  increases  the  loss 
of  heat  by  radiation,  reducing  the  temperature  rapidly.  Some- 
times it  may  cause  dangerous  symptoms,  such  as  a  feeble 
pulse,  profuse  diaphoresis  and  collapse.  It  is  employed  in 
typhoid  and  malarial  fevers,  pneumonia,  phthisis,  neuritis, 
sciatica,  locomotor  ataxis,  neuralgia  of  the  fifth  pair  of  nerves 
associated  with  neuritis  and  sciatica,  migraine,  acute  rheuma- 
tism, epilepsy,  chorea,  etc.,  and  as  a  substitute  for  morphine, 
and  in  the  morphine  habit. 

Its  administration  is  soon  followed  by  profuse  perspiration, 
coldness  of  the  surface,  slowed  pulse,  depression,  and  if  fever 
is  present  by  lowered  temperature  within  a  half  hour  after 
taking  the  drug.  In  health  its  use  may  cause  slight  nausea, 
singing  in  the  ears,  and  a  slight  decrease  in  the  temperature  of 
the  body.  It  has  no  effect  upon  respiration,  but  acts  as  a 
sedative  upon  the  brain.  It  is  eliminated  by  the  kidneys, 
appearing  in  the  urine  about  three  hours  after  ingestion. 

Dose. — Grs.  v  to  grs.  Ix,  being  determined  by  its  uses.  Sub- 
cutaneously  injected,  it  is  very  effective  in  painful  affections 
originating  in  the  nerves. 

The  hypodermic  use  of  antipyrine  has  given  very  satisfac- 
tory results  in  the  treatment  of  nervous  articular  and  muscular 
pains,  gastric  affections,  bronchial  asthma,  articular  rheuma- 
tism, chronic  lumbago.  A  painless  injection  may  be  made  by 
half-filling  a  hypodermic  syringe  with  a  fifty  per  cent,  solution 
of  antipyrine,  which  will  amount  to  about  five  and  a  half 
grains;  then  immerse  the  syringe  into  a  ten  per  cent,  solution 
of  cocaine,  drawing  up  enough  of  the  cocaine  into  the  syringe 
to  make  it  about  three-fourths  full;  this  will  amount  to  one- 
third  grain  of  cocaine.  The  two  solutions  readily  mix  and  do 
not  decompose,  and  may  be  used  as  a  local  anaesthetic. 

Dental  Uses. — Antipyrine  is  used  hypodermically  with  great 
success  in  cases  of  severe  neuralgia  of  the  fifth  pair  of  nerves. 
Also,  in  cases  of  acute  pericemental  irritation,  and  in  reflex 
neuroses  of  dental  origin  it  has  given  great  relief.  Fifteen 
grains  in  half  an  ounce  of  water  have  P"iven  relief  in  a  case  of 


264  DENTAL  MEDICINE. 


pericementitis,  ceasing  in  twenty  minutes  with  no  return  of 
the  pain:  but  many  prefer  antifebrin  (acetanihde)  as  being  safer 
than  antipyrine.  It  also  has  a  marked  effect  in  controUing 
hemorrhage  from  the  gums  and  alveolar  cavities  when  used  as 
a  hsemostatic  after  the  extraction  of  teeth.  Prof  G.  Cesari 
claims  that  antipyrine  more  or  less  speedily  arrests  hemorrhage 
from  both  large  and  small  blood-vessels  when  applied  in  solu- 
tions of  not  less  than  forty,  or,  better,  fifty  per  cent.  The 
solution  as  well  as  the  powder  should  be  applied  on  pledgets 
of  cotton  wool.  Antipyrine  has  also  been  administered  inter- 
nally with  satisfactory  results  in  the  treatment  of  periodontitis; 
and  in  cases  where,  owing  to  the  severity  of  the  symptoms  in 
the  same  affection,  the  internal  administration  has  proven 
unsuccessful,  the  hypodermic  injection  of  fifteen  grains  has 
afforded  relief;  or  the  hypodermic  injection  followed  in  one 
half  hour  by  the  internal  administration  of  fifteen  grains  of  the 
drug  will  afford  relief  in  cases  of  acute  periodontitis. 

Antipyrine  has  been  successfully  used  for  arresting  hemor- 
rhage after  the  extraction  of  teeth,  as  it  has  none  of  the  dis- 
agreeable effects  of  perchloride  of  iron.  It  is  applied  on 
cotton. 

For   Nervous    Cases. 

R.        Antipyrine gr.xviij 

Aq.  destillat q.s.  ad  ft.  sol. 

Ft.  sol  et  adde 

Acidi  valerianici , gtt.xv. 

Shake  well  and  stand  aside  to  allow  salt  to  crystallize. 

Local  AtKzsihetic. 
Dr.   J.  E.  Davis. 

R.        Antipyrine  (5  per  cent.) grs.xxiij 

Cocaine  (10  per  cent.) grs.48 

Menthol grs.v 

Oil  cloves gtts.iij 

Ether gtts.xx 

Glycerine ^j 

Water  (pure) ^j.  M. 

SiGNA. —  Use  with  hypodermic  syringe. 


NITRATE  OF  SILVER.  265 


ANTISEPTIC   AND   STYPTIC   COTTON-WOOL. 

Antiseptic  Cotton. — First  free  the  ordinary  cotton-wool  from 
grease,  by  macerating  it  in  benzine  for  ten  minutes,  press 
and  dry  in  the  air.  Then  steep  the  purified  cotton,  for  ten 
minutes,  in  a  solution  of  tannin  5,  carbolic  acid  4,  alcohol  50, 
and  castor  oil  8  parts. 

Styptic  Cotton-  Wool. — Purify,  as  before,  with  benzine,  dry  in 
air,  and  then  steep  it  in  a  solution  of  alum  2,  water  12,  chlor- 
ide of  iron  solution  2  parts;  dry  at  60°  C. 

AQUA  DESTILLATA— DISTILLED  WATER. 

Derivation. — "  Take  of  water  80  pints.  Distill  two  pints, 
using  a  tin  or  glass  condenser,  and  throw  them  away ;  then 
distill  64  pints, and  keep  them  in  glass  bottles." — U.S.D, 

Properties. — Distilled  water  has  a  vapid,  and  by  no  means 
pleasant  taste,  and  is  only  perfectly  pure  when  the  vessel  used 
in  the  distillation  is  of  silver.  It  should  evaporate  without 
residue. 

Therapeutic  Uses. — It  is  very  essential  in  the  preparation  of 
some  formulae,  and  of  no  use  whatever  in  others,  as  the  com- 
mon pure  water  will  answer.  Such  agents  as  tartar  emetic, 
nitrate  of  silver,  corrosive  sublimate,  chlorides  of  calcium, 
barium,  acetate  and  subacetate  of  lead,  permanganate  of 
potassa,  the  sulphates  of  iron  and  zinc,  sulphate  of  quinia,  the 
salts  of  morphia,  and  all  the  alkaloids  and  their  salts,  require, 
when  given  in  solution,  distilled  water. 

Dental  Uses. — Distilled  water  is  required  in  the  preparation 
of  many  formulae  for  use  in  dental  practice. 

ARGENTI  NITRAS— NITRATE  OF  SILVER. 
LUNAR  CAUSTIC. 

Formula. — AgNOg. 

Derivation. — Nitrate  of  Silver  is  obtained  by  dissolving 
silver  in  nitric  acid  and  distilled  water,  and  evaporating  the 
solution.  It  is  in  the  form  of  a  heavy,  colorless,  anhydrous 
salt,  and  crystallizes  in  shining,  rhombic  plates.  The  action  of 
light  and  organic  matters  causes  it  to  turn  black.  It  is  wholly 
soluble  in  distilled  water,  the  only  preparation  of  water  that 


266  DENTAL  MEDICINE. 


should  be  employed  in  forming  solutions  of  this  salt.  It  has  a 
strong,  metallic,  styptic  taste.  In  the  preparation  of  the  solid 
form  of  sticks,  it  is  first  melted  and  poured  into  moulds, 
exposure  to  the  light  causing  the  sticks  to  become  gray,  and 
more  or  less  dark,  owing  to  the  reduction  of  the  silver  by  the 
sulphuretted  hydrogen  contained  in  the  atmosphere  ;  hence, 
on  account  of  the  decomposition  of  this  salt,  it  should  be 
carefully  excluded  from  the  light. 

Medical  Properties  a7id  Action. — Nitrate  of  silver  is  tonic, 
antispasmodic,  sedative  and  astringent.  When  applied  to  the 
skin,  mucous  membrane,  or  ulcers,  it  produces,  at  first,  a  white 
appearance,  owing  to  its  union  with  the  coagulated  albumen  of 
the  cuticle,  but  this  gradually  changes  to  a  bluish-gray,  purple, 
and  finally,  black  color,  on  account  of  the  partial  reduction  of 
the  silver  by  the  sulphuretted  hydrogen.  Small  doses,  ad- 
ministered for  a  long  time,  give  a  peculiar  blue  appearance  to 
the  skin.  When  internally  administered,  it  has  an  astringent 
action  on  the  mucous  coats  of  the  intestines.  It  is  a  powerful 
tonic  to  the  nervous  system,  and  has  been  chiefly  employed 
as  an  antispasmodic  tonic.  It  is  chiefly  used  externally,  as  a 
stimulant,  vesicant,  and  escharotic.  If  applied,  even  lightly, 
three  or  four  times,  to  the  moistened  skin,  it  will  cause 
vesication  in  a  few  hours.  The  blue  appearance  on  the  skin, 
when  small  doses  are  long  continued,  is  said  to  be  preceded 
by  a  peculiar  blue  line  on  the  gums,  like  that  from  lead 
poisoning.  A  very  minute  quantity  of  this  salt,  when  inter- 
nally administered,  is  eliminated  by  the  kidneys,  as  most  of  it 
escapes  by  the  liver  and  the  intestinal  glands,  a  portion 
remaining  permanently  deposited  in  the  tissues,  when  its  use 
has  been  long  continued.  Six  weeks  is  the  length  of  time  it 
is  safe  to  continue  its  internal  use,  and  during  that  time  occa- 
sional purgatives  should  be  given,  to  promote  its  elimination. 
The  persistent  use  of  iodide  of  potassium  and  the  hyposul- 
phite of  soda  will  cause  the  absorption  and  excretion  of  the 
silver  deposits,  in  cases  of  skin  discoloration  from  its  long- 
continued  use,  aided  by  baths  of  the  hyposulphites,  and  the 
very  careful  use  of  lotions  containing  cyanide  of  potassium, 


NITRATE   OF   SILVER.  267 

which  possesses  a  solvent  power  over  silver  deposits.  As  long 
as  inflammation  is  present,  it  should  not  be  internally  admin- 
istered, arid  during  a  course,  it  should  be  occasionally  inter- 
mitted for  a  few  days,  and  a  purgative  used.  The  gums  and 
fauces  should  be  frequently  examined,  and  if  the  slightest  blue 
discoloration  is  observed,  the  remedy  should  be  discontinued. 
Exposure  to  the  sun  should  be  avoided. 

Therapeutic  Uses. — Nitrate  of  Silver  is  internally  employed 
in  dyspepsia,  chronic  gastritis,  chronic  diarrhoea  and  dysen- 
tery, cholera,  diseases  of  the  eye,  chorea,  epilepsy,  asthma 
and  whooping  cough. 

Externally  in  ophthalmia  and  other  diseases  of  the  eyes, 
cutaneous  diseases,  diphtheria,  erysipelas,  hydrophobia,  en- 
largement of  glands,  diseases  of  the  genito-urinary  organs, 
diseases  of  the  ear,  burns,  ulcers,  hemorrhage,  etc.,  etc. 

Dose. — Of  nitrate  of  silver,  gr.  i,  gradually  increased  to 
gr.  ^  three  times  a  day,  in  pill  made  of  some  vegetable  pow- 
der, or  in  solution.  The  fused  nitrate  of  silver — Argenti 
Nitras  Fusa — or  solid  form,  is  used  externally. 

Dental  Uses. — For  inflamed  and  ulcerated  conditions  of  the 
mucous  membrane  of  the  mouth,  nitrate  of  silver  is  a  valua- 
ble application,  in  the  form  of  injections  or  solutions  of  various 
strengths,  from  gr.  ij  to  5ss  of  distilled  water ;  also  in  diseases 
of  the  antrum  and  fistula,  as  an  injection.  It  is  also  used  as  a 
styptic,  for  the  arrest  of  alveolar  hemorrhage,  but  is  not  so 
reliable  as  tannic  acid,  gallic  acid,  etc.,  on  account  of  the 
coagulum  or  clot  formed  by  it,  being  soluble  in  an  excess  of 
albumen.  It  is  also  employed  to  obtund  the  sensitiveness  of 
dentine,  especially  where  the  cause  is  mechanical  abrasion  ; 
also  in  aphthee,  mercurial  stomatitis,  ulceration  of  the  gums, 
salivary  fistula,  alveolar  abscess.  For  obtunding  sensitive 
dentine,  the  stick  form  (one  end  of  a  stick  inserted  into  a 
quill,  or  fused  on  the  end  of  a  platinum  wire)  is  employed  ; 
or  the  end  of  a  silver  wire  may  be  immersed  in  nitric  acid,  and 
applied  to  the  sensitive  surface,  takfng  care  to  limit  its  action 
to  the  part  on  which  it  is  to  act.  When  applied  to  sensitive 
dentine,  it  acts  on  the  gelatinous  portion  of  the  tooth,  destroy- 


268  DENTAL   MEDICINE. 


ing  its  vitality  to  the  extent  of  the  combination  which  takes 
place.  The  objection  to  its  use  in  such  cases  is  the  discolora- 
tion it  causes. 

Dr.  C.  N.  Peirce  recommends  saturating  blotting  paper 
with  a  40  per  cent,  solution  of  nitrate  of  silver  for  application 
to  children's  teeth,  as  it  cauterizes  the  soft  tissues  and  acts 
upon  the  hard  in  a  satisfactory  manner  without  danger  or 
staining  the  fingers ;  asbestos  paper  or  felt  may  also  be  sat- 
urated with  the  nitrate  of  silver  for  use  in  the  mouth.  Dr. 
Kirk  recommends  thin  asbestos  felt,  as  being  better  than  paper. 
Before  saturating  the  asbestos  felt,  it  should  be  heated  to  red- 
ness over  a  Bunsen  burner  to  burn  out  any  organic  matter 
with  which  it  may  be  accidentally  contaminated. 

As  salt  decomposes  the  nitrate  of  silver,  a  solution  of  the 
chloride  of  sodium  will  relieve  the  excessive  pain  following 
its  application  to  sensitive  dentine,  or  to  ulcers  of  the  mouth; 
such  a  solution  will  also  remove  recent  stains,  if  folldwed  by 
the  application  of  a  solution  of  ammonia.  Old  stains  may  be 
removed  with  tincture  of  iodine,  followed  by  cyanide  of 
potassium.  * 

A  convenient  way  to  keep  nitrate  of  silver  ready  for  use  is 
to  soak  asbestos  fibre  in  a  saturated  solution,  and  allow  it 
to  dry. 

The  antidote  in  cases  of  poisoning  by  nitrate  of  silver  is 
chloride  of  sodium  (common  salt),  which  converts  it  into 
chloride  of  silver,  to'  be  followed  by  emetics,  and  the  proper 
antiphlogistic  treatment. 

DENTAL  FORMULA. 
For  Inflamed  and    Ulcerated  Mucous  For  Ulcers  and  Aphthce. 

Membrane.  d       a         ..•     v    *•  „ 

Jti .    Argenti  mtratis    .    .    .  3  ss 

R.    Argenti  nitratis     .  gr.ij  to  ^ss  AquEe  destillatse  .    .    .  3J.        M. 

Aqu3e  destillatse   .    .    .    .  f^j.  M.       SiGNA. — To  be  applied  with  a  camel- 

SlGNA. — To  be  used  as  a  lotion.  hair  brush. 

For  Diseases  of  the  Anh'um.  For  Mercurial  Stomatitis. 

R.    Argenti  nitratis    .  gr.j  to  gr.v  R,    Argenti  nitratis         .    .  gr.ss 

Aquae  destillatse  ....  f,^j.   M.  Aquee  destillatse  .    .    .  f^j.       M. 

SiGNA. — To  be  used  as  an  injection.  SiGNA. — To  be  used  as  a  mouth-wash. 


ARISTOL.  269 


ARISTOL— DITHYMOL-DIIODIDE— DITHYMOL-BINIODIDE. 

Formitla — C2gH2o(OI)2. 

Derivation. — Aristol  is  obtained  by  adding  a  solution  of 
iodine  in  iodide  of  potassium,  to  an  equal  solution  of  hydrate 
of  sodium,  containing  thymol.  It  is  in  the  form  of  a  red- 
brown,  precipitated,  armorphous,  non-crystallizable  powder. 
The  proportion  of  iodine  in  aristol  has  been  estimated  by 
Carius  at  45„8o  per  cent.  Aristol  is  insoluble  in  water  and 
glycerine,  slightly  soluble  in  alcohol,  but  readily  soluble  in 
chloroform,  ether,  and  in  the  essential  oils ;  but  the  solution 
must  be  made  by  friction  without  heat,  as  the  aristol  is  decom- 
posed by  heat  and  also  by  light.  It  possesses  but  a  slight 
odor,  like  that  of  thymol,  and  is   not  unpleasant. 

Medical  Properties  and  Therapetttic  Uses. — Aristol  possesses 
no  irritant  action  upon  the  unbroken  skin,  and  when  applied 
to  mucous  membrane  it  promotes  absorption.  Not  being 
absorbed,  it  has  no  toxic  effect,  and  for  such  reason,  together 
with  its  freedom  from  disagreeable  odor,  it  possesses  a  great 
advantage  over  iodoform.  It  produces  rapid  healing,  and  has 
been  employed  with  benefit  in  varicose  ulcers  as  a  dusting 
powder;  also  in  cutaneous  diseases,  gonorrhoea,  gleet,  in 
operations  of  anal  fistula,  abscess,  lymphadentitis,  periostitis, 
psoriasis,  ulcers,  etc.,  etc.  It  is  chiefly  employed  as  a  dusting 
powder,  or  in  ethereal  solutions  or  ointments,  epithelioma, 
burns  and  scalds.  Aristol  is  considered  to  be  an  excellent 
and  prompt  antiseptic,  but  the  name  is  merely  an  assumed  one 
for  dithymoldic  iodine.  Impurities  in  aristol  would  be  all  the 
by-products  derived  from  unskillful  treatment ;  it  might  con- 
tain potassium  or  sodium  iodide,  or  free  iodine;  it  might  be 
adulterated  even,  for,  as  a  patented  article,  it  is  above  control, 
as  patents  have  been  granted  by  the  U.  S.  Patent  Office  for 
its  control,  manufacture  and  sale  under  the  name  of  "  aristol," 
being  a  compound  of  thymol  with  iodine.  The  virtues  of 
aristol  over  iodoform,  etc.,  have  as  yet  not  been  so  pro- 
nounced as  to  exclude  it  from  the  general  class  of  patented 
medicines. 


270  DENTAL   MEDICINE. 

Dental  Use. — Aristol  has  been  used  as  a  substitute  for  iodo- 
form, iodol,  carbolic  acid,  etc.,  etc.,  in  all  cases  when  the  ordi- 
nary antiseptics  are  indicated,  as  in  gangrenous  pulps,  anti- 
septicizing  of  root-canals,  disinfection  of  cavities  before  the 
introduction  of  fillings,  in  the  form  of  a  lo  per  cent,  solution 
in  sulphuric  ether  for  disinfecting  purposes ;  for  gangrenous 
pulps,  the  aristol  in  solid  form  may  be  applied  with  a  small 
brush.  Sticks  made  of  cacao  butter  lO  parts,  and  aristol  i 
part,  may  be  used  to  promote  granulation  and  healing.  Aris- 
tol has  the  advantage  of  being  effective  in  small  quantities, 
and  may  be  diluted  with  sugar  of  milk. 

Dr.  E.  C.  Kirk  highly  recommends  aristol  for  alveolar 
pyorrhoea,  a  lo  per  cent,  solution  being  rubbed  upon  a  glass 
plate  with  oil  of  cinnamon  and  introduced  into  each  suppu- 
rating pocket,  and  around  the  root  at  the  base  of  each  pocket, 
on  threads  of  absorbent  cotton  saturated  with  the  solution ; 
the  oil  of  gaultheria  may  be  substituted  for  the  oil  of  cinna- 
mon if  desired.  Dr.  Kirk  and  others  also  recommend  aristol 
in  the  essential  oils  as  a  medicament  for  canal-dressings,  and 
as  a  topical  dressing  in  acute  pulpitis.  Dr.  Kirk  recommends 
that  as  a  root-canal  dressing,  its  use  should  be  strictly  confined 
to  those  cases  where  pericemental  inflammation  is  not  a  present 
factor,  as  it  does  not  possess  antiseptic  qualities  sufficiently 
powerful  to  overcome  quickly  septic  conditions  due  to  the 
putrefactive  changes  common  in  root-canals.  He  also  finds  it 
extremely  valuable  in  connection  with  gutta  percha,  as  an 
antiseptic  in  conjunction  with  permanent  root  fillings — aristol 
with  chloroform  being  used  to  dissolve  the  gutta  percha.  It 
is  also  recommended  as  an  ingredient  of  nerve  paste,  being 
equal  to  iodoform  for  such  a  purpose,  but  free  from  the  dis- 
agreeable odor  of  the  latter  substance;  it  is  also  used  in 
chloroform  solution,  instead  of  sandarach  varnish,  for  saturat- 
ing cotton  used  for  wedges  or  temporary  fillings  in  retaining 
medicaments  in  cavities  in  the  teeth  ;  such  a  dressing  or  wedge 
may  be  retained  for  days  or  a  week,  and  being  antiseptic,  it  is 
free  from  disagreeable  odor  daring  that  time.  Aristol  is  also 
recommended  as  a  dressing  where  approximal  caries  has  ex- 


ARNICA.  271 

tended  beyond  the  gum  margin,  and  where  hypertrophy  of 
the  gum  festoon  occurs  to  the  degree  of  forming  a  polypoid 
growth  which  invades  the  cavity;  also  in  the  form  of  a  varnish 
it  is  combined  with  collodion  as  a  pulp-capping  material.  To 
increase  the  adhesiveness  of  the  aristol  solution,  a  small  quan- 
tity of  Canada  balsam  may  be  added  to  it. 

Dr.  R.  M.  Chase  recommends  an  aristol  chloro-percha  root 
filling  composed  of  two  grains  of  aristol  in  one  drachm  of 
chloro-percha. 

DENTAL   FORMULA. 
For  Alveolar  Abscess  and  A^ecrosed   Teeth. 

Dr.  S.  Clippinger. 

R.        Aristol 5J 

Chloroform §js 

01.  Cassite TTLx.  M. 

SiGNA. — Apply  on  cotton  wrapped  around  a  small  broach. 

ARNICA. 
LEOPARD'S   BANE. 

Source. — Arnica  Montana  is  a  perennial,  herbaceous  plant 
of  which  the  dried  flowers  and  root — ArniccB  Flores  and  ArniccE 
Radix — are  the  medicinal  portions,  and  is  found  in  the  moun- 
tains of  Northern  Europe  and  the  Northwestern  portions  of 
America. 

Medical  Properties  and  Action. — Arnica  is  nervine,  stimulant, 
and  diaphoretic.  In  over-doses  it  is  an  acro-narcotic  poison, 
causing  vomiting,  purging,  vertigo,  tetanic  twitching  of  the 
muscles,  and  convulsions.  Moderate  doses,  when  long  con- 
tinued, are  liable  to  cause  a  very  troublesome  eruption.  Its 
activity  depends  upon  an  alkaloid — Arnicina,  which  is  a  bitter 
and  acrid  extractive. 

Therapeutic  Uses. — Arnica  is  administered  internally  in 
typhus  and  typhoid  fevers,  chronic  dysentery,  rheumatic  gout, 
etc.,  etc.  Externally  to  bruises,  sprains,  lacerations,  chilblains, 
etc.,  in  the  form  of  tincture — Tinctura  Arnica.  The  [antidote 
for  poison  by  arnica  is  common  vinegar. 

Dose. — Of  the  extract  of  arnica,  gr.  v  to  gr.  x.  Of  the  tinc- 
ture of  arnica  (arnica  root  5J,  rectified  spirit  Oj),  the  dose  is 
TTLx  to  f5ss. 


272 


DENTAL  MEDICINE. 


Dental  Uses. — In  dental  practice,  the  tincture  of  arnica  is 
applied  to  irritable  pulps  of  teeth,  in  periodontitis  to  prevent 
suppuration,  to  wounds  of  the  mucous  membrane  of  the 
mouth,  combined  with  glycerine,  to  abraded  surfaces  caused 
by  artificial  teeth,  and  with  tannic  acid  or  glycerine  of  tannin 
for  ulcers  of  the  mouth. 

The  tincture  of  arnica,  when  largely  diluted  with  water, 
forms  an  efficient  mouth-wash  during  operations  upon  the 
teeth.  Equal  parts  of  tincture  of  arnica  and  glycerine  diluted 
with  water  form  an  effective  mouth-wash  in  inflammations  of 
the  mucous  membrane  of  the  mouth. 


DENTAL     FORMULAE 

I*'or  Abraded  Surfaces  of  the  Mucous 

Membrane  of  the  Alouth. 
R.    Tincturee  arniccC, 

Glycerini  ......  aa  ^j.    M 

SiGNA. — To  be  used  as  a  lotion. 


For  Ecchymosis. 

R .  Tincturse  arnicse  .  .  .  ,^  ss 
Liquor  ammonii  muriat.  ^  ss 
Aquse ^v. 

SiGNA. — To  be  used  as  a  lotion. 


M. 


Astringent  Motith-Wash  in    Alveolar 
Pyorj-hxa,    etc. 

Dr.  J.  R.  Bell. 
R. 


M. 


Tincturas  arnicse  .    . 

•  3J 

Acidi  carbolici    .    . 

•  m^x 

Tincturse  myrrhae    . 

.  gss 

Olei  gaultherise    .    . 

•  3Jss 

Alcoholis 

.  gijss 

For  Inflamed  and    Ulcerated  Mucozis 
Membrane. 

R.    Tincture  aniicge  .    .    .  ^ij 

Glycerini ^ij 

Aquae  rosEe §  ij 

Aquse  destillatae  .    .    .  ^  x.       M. 

SiGNA. — To  be  used  as  a  gargle. 


ATROPINE   SULPHAS— SULPHATE   OF  ATROPINE. 
ATROPINE. 

Formula. — C17H23NO3. 

Derivation. — Sulphate  of  Atropine  is  obtained  by  adding  a 
mixture  of  sulphuric  acid  to  an  ethereal  solution  of  atropine. 
It  is  in  the  form  of  a  white,  slightly  crystalline  powder,  very 
soluble  in  water  and  alcohol,  but  insoluble  in  ether.  It  is 
inodorous,  and  of  a  bitter  taste. 

Medical  Properties  and  Action. — Sulphate  of  atropine  has  the 
same  medical  properties  and  action  as  belladonna,  of  which 
it  is  the  alkaloid,  but  is  far  more  energetic  in  its  action.  It  is 
an  active  poison,  and  should  only  be  administered  internally 
with  the  greatest  care.     Hypodermically  employed,  it  is  a 


SULPHATE   OF  ATROPINE.  '  273 

useful  anodyne  and  antispasmodic,  and  the  quantity  should  be 
cautiously  increased  from  a  very  small  dose  in  the  beginning. 
Such  symptoms  as  dryness  of  the  throat,  vertigo,  and  diplopia, 
are  indications  that  its  use  should  be  discontinued.  Without 
being  a  direct  hypnotic,  it  induces  sleep  by  relieving  pain. 
Although  it  is  not  so  well  tolerated,  as  a  general  rule,  as  is  mor- 
phine, yet  patients  who  cannot  bear  morphine  will  bear  atropine. 

Therapeutic  Uses. — See  Belladonna. 

Dose. — Of  sulphate  of  atropine,  gr.  i\^  to  gr.  eV.  For  an 
anodyne  and  antispasmodic,  hypodermically  injected,  the  dose 
is  'niij=gr.  lio,  as  a  commencement.  An  ointment  is  made 
of  atropine  gr.  viij,  rectified  spirit  fjss,  lard  oj. 

The  antidote  in  cases  of  poisoning  by  Belladonna  and  its 
alkaloid  is  an  infusion  of  galls  and  lime  water,  first  evacuating 
the  stomach  as  speedily  as  possible. 

Dental  Uses. — In  dental  practice,  sulphate  of  atropine  is 
applied  externally  to  obtund  the  sensitiveness  of  inflamed 
pulps  of  teeth,  preparatory  to  their  treatment,  and  to  their 
devitalization;  it  is  also  applied  to  acute  inflammation,  depend- 
ing upon  alveolar  periostitis  and  abscess.  It  forms  one  of  the 
ingredients  of  a  nerve  paste,  for  devitalizing  pulps  of  teeth, 
being  substituted  for  the  acetate  of  morphine,  but  there  is 
doubt  as  to  its  being  so  effective  as  the  morphine  salts;  in 
facial  neuralgia,  in  the  form  of  an  ointment;  in  neuralgia  and 
in  profuse  salivation.  As  an  anodyne  for  internal  use,  it  proves 
efficacious  in  relieving  intense  pain,  such  as  may  result  from 
an  inflamed  pulp  or  periosteum;  also  internally,  or  in  the  form 
of  hypodermic  injections,  for  the  relief  of  facial  neuralgia; 
for  such  a  purpose  T20  of  a  grain  of  the  atropine  sulphate  is 
often  combined  with  morphine  sulphate. 

DENTAL    FORMUL/E. 
For  Facial  Neuralgia,  For  Neuralgia. 

R .    Atropinse  sulphat     .    .  gr.j  J.  L.  Ludlow. 

Adipis 3J.         M.       R.    Atropinse  sulphatis  .    .  gr.ss 

SiGNA. — To  be  applied  in  the  form  of  Aconitinse gr.iss 

an  ointment,  over  seat  of  pain.  Olei  tiglii gtt-ij 

Ung.  petrolei   .    .    .    .  ^ij.       M. 
18  SiGNA. — Apply  externally. 


274  *  DENTAL   MEDICINE. 


For  Facial  Ne2iralgia,  For  Facial  Neuralgia. 

R.    Pulveris  belladonnse    .  ^x  R.    Ext.  belladonnag  .    .    .  gr.ss 

Camphoras ^ss  Quininae  sulphat  .    .    .  gr.ij.       M. 

Spiritus  rectificati     .    .  q.s.         M.  Ft.  pil.  No.  i. 

SiGNA. — To  be  applied  with  a  camel-  Signa. — Use  3  times  daily. 

hair  brush.  „       „     .   ,    ,  ^         _   . 

ror  racial  Neuralgia. 

77       T,T        ,  ■      ^   c  J.    j:  ■  T   HT  R.    Linimenti  belladonae. 

For  Neuralgia  of  Superficial  Nerves.  ...  ' 

Linimenti  aconiti    ,    .  aa  ^:^  vij 

AiTKEN.  Chloroformi f^ij-  ^• 

Signa. — To  be  applied  as  a  lotion,  on 
^'  P  P  •    •  s^'  lint  saturated  with   it,  and   covered 

Aqu^  destillat     .    .    .  fgiii.     M.  ^ith  oiled  silk. 

Signa. — Use  on  a  compress  and  renew 

several  times  in  24  hours,  and  con-      Pof  Neuralgia  in  Superficial  Nerves. 
tinue  for  at  least    i  hour  at  a  time,      R.    Chloroformi, 

covering    with    oilskin,    to    prevent  Spts.vini  rect aa  ^ss 

evaporation.  •  Atropinse  sulphat     .    .  gr.v.        M. 

Signa. — To   be    applied    on    lint    to 
painful  part,  and  covered  with  oiled 
^  silk. 

For  Neuralgia. 

R .        Ext.  belladonnse gr.iv 

Ext.  stramonii gr.v 

Ext.  hyoscyapai gr.v 

Quininse  sulphat ^ij.  M. 

Ft.  pil.  No.  XX. 
Signa. — One  pill  2  or  3  times  a  day. 

AURUM  TERCHLORIDUM— TERCHLORIDE  OF  GOLD, 

Formula. — Au  CI3. 

Derivation. — The  Terchloride  of  Gold  is  obtained  by  dis- 
solving gold  in  aqua  regia  (three  parts,  by  measure  of  hydro- 
chloric acid,  and  one  of  nitric  acid),  using  gentle  heat  to 
hasten  the  solution,  the  acids  employed  being  chemically 
pure.  The  solution  is  then  evaporated  to  dryness,  when 
ruby-red  prismatic  crystals  of  the  terchloride  of  gold  result. 

Properties  and  Action. — Terchloride  of  gold  is  very  deli- 
quescent, and  is  soluble  in  water,  alcohol  and  ether.  It 
possesses  a  disagreeable,  styptic  taste,  reddens  blue  litmus 
paper,  and  will  impart  a  purple  stain  to  the  skin,  which  may  be 
removed  by  a  solution  of  cyanide  of  potassium.  It  is  readily 
decomposed  by  many  metallic  and  non-metallic  elements,  and 


BELLADONNA.  275 


also  by  saline  and  organic  compounds,  on  account  of  its  ele- 
ments being  held  together  by  a  feeble  affinity.  It  is  escharotic 
and  disinfectant,  and  its  physiological  effects  are  similar  to 
those  of  corrosive  sublimate.     It  is  not  used  internally. 

Dental  Uses. — In  dental  practice,  the  terchloride  of  gold, 
in  the  form  of  an  aqueous,  alcoholic,  or  ethereal  solution,  is 
employed  for  the  purpose  of  obtunding  the  sensitiveness  of 
dentine,  for  which  it  is  a  valuable  application;  and  the  ethereal 
solution  possesses  some  advantages  over  the  aqueous  or  alco- 
holic solutions  for  such  a  purpose.  To  prepare  an  obtunding 
solution:  "Dissolve  the  crystals  of  the  gold  in  pure  water;  fill 
a  test-tube  half  full  of  the  solution,  then  add  an  equal  quantity 
of  sulphuric  ether,  and  agitate  the  mixture.  Let  it  then  rest 
for  a  few  minutes,  when  the  ethereal  solution  will  rise  to  the 
surface,  and  may  be  poured  off  into  another  tube  or  phial,  and 
securely  stoppered.  It  should  be  kept,  as  much  as  practicable, 
from  the  action  of  light  and  air.  Applied  to  dentine,  on 
pledgets  of  cotton,  it  acts  like  chloride  of  zinc,  but  more 
promptly  and  with  less  pain.  Chlorine  is  more  abundantly 
liberated  during  its  action  than  from  chloride  of  zinc ;  hence 
it  is  a  better  disinfectant  than  the  latter.  It  has  a  fine  yellow 
tint,  and  it  is  not  absorbed  by  the  dentine,  but  forms  an  in- 
soluble compound  with  the  gelatinous  elements.  As  it  is  an 
irritant  poison,  care  should  be  observed  in  its  use.  If  not 
protected  in  a  glass-stoppered  bottle,  the  gold  is  precipitated 
in  a  metallic  form. 

BELLADONNyE  FOLIA— BELLADONNA  LEAVES. 
BELLADONNA  RADIX— BELLADONNA  ROOT. 

DEADLY  NIGHTSHADE. 

Source. — Belladonna  is  a  perennial,  herbaceous  plant,  found 
in  Europe,  the  leaves  and  root  being  the  medicinal  portions. 

Medical  Properties  and  Action. — Belladonna  is  anodyne  and 
antispasmodic,  its  activity  depending  upon  an  alkaloid,  Atro- 
pine. Belladonna,  in  small  doses,  is  a  valuable  narcotic  and 
anodyne  stimulant.  It  causes  a  peculiar  dryness  of  the  mouth, 
fauces,  stomach  and  intestines,  but  increased  secretion  follows 


276  DENTAL  MEDICINE. 


especially  in  the  case  of  the  latter  organs,  when  atropine  is 
administered  or  subcutaneously  injected.  In  larger  doses,  it 
causes  dilatation  of  the  pupils,  giddiness,  loss  of  vision,  difficult 
deglutition,  constriction  of  the  throat,  difficult  articulation, 
increased  action  of  the  heart,  quickened  respiration,  nausea, 
vomiting,  diuresis,  purging,  and  sometimes  a  red  eruption.  It 
is  eliminated  chiefly  by  the  urine. 

Opium  is  the  antidote,  or  hypodermic  injections  of  mor- 
phine. When  applied  to  the  eyebrows,  belladonna  causes 
dilatation  of  the  pupils. 

Therapeutic  Uses. — Belladonna  is  extensively  employed, 
either  alone  or  in  combination  with  sulphate  of  quinia,  in  the 
treatment  of  neuralgia ;  also  in  mania,  Bright's  disease,  epi- 
lepsy, lead  colic,  spasmodic  affections,  diseases  of  the  cerebro- 
spinal system,  as  a  preventive  of  scarlatina,  night  sweats  of 
phthisis,  etc. 

Dose. — Of  powdered  belladonna,  gr.  ss  to  gr.  j,  daily;  of 
the  extract,  gr.  y^  to  gr.  j ;  of  the  tincture,  gtt.  v  to  gtt.  xx. 
(See  Atropine.) 

BENZOIC  SULPHIDE  OF  SODIUM. 
Benzoic  Sulphide  of  Sodium  is  obtained  by  dissolving  a 
large  quantity  of  benzoic  acid  in  a  concentrated  solution  of 
sulphide  of  sodium.  It  is  a  valuable  antiseptic  for  dressing 
wounds,  and  may  be  used  as  a  wash,  lotion  or  injection,  its 
antiseptic  properties  being  very  active  and  healing.  Thirty  to 
forty-five  grains  are  used  to  the  quart  of  water.  Heckel  con- 
siders it  to  be  equal  to  carbolic  acid,  and  superior  both  to 
sublimate  and  iodoform,  as  it  is  not  poisonous  like  corrosive 
sublimate,  and  is  free  from  the  disagreeable  effects  of  iodoform. 
It  is  very  soluble  in  water  and  contains  the  antiseptic  proper- 
ties of  its  two  principal  ingredients — benzoic  acid  and  sulphite 
of  sodium.     It  is  harmless,  even  when  given  in  large  doses. 

BISMUTHI  SUBNITRAS— SUBNITRATE  OF  BISMUTH. 
Formula.— '^xO'^O-^  +  Yif).     • 

Derivation — The  metal  Bismuth — Bismuthum,  Formula  Bi, 
from  which    the    subnitrate    is    obtained,   is  found  native  in 


SUBNITRATE   OF   BISMUTH.  277 

Europe  and  America,  and  generally  in  combination  with  sul- 
phur and  oxygen.  It  fuses  at  476°  F.,  and  is  brittle  and 
pulverizable.  It  is  employed  in  the  dental  laboratory  for 
making  fusible  metal  alloys  for  dies  and  counter-dies. 

The  Subnitrate  of  Bismuth  is  obtained  by  dissolving  the 
metal  bismuth  in  dilute  nitric  acid,  and  converting  the  nitrate 
thus  formed  into  carbonate,  by  adding  a  solution  of  carbonate 
of  sodium,  which  is  then  dissolved  in  nitric  acid  and  the 
nitrate  of  bismuth  again  formed,  which  is  washed  in  water  and 
the  nitric  acid  removed  by  ammonia.  Such  a  process  frees  it 
from  the  arsenious  acid  which  metallic  bismuth  generally  con- 
tains. Subnitrate  of  bismuth  is  in  the  form  of  a  heavy,  white 
powder,  with  a  faint  acid  odor  and  slightly  metallic  taste,  and 
is  insoluble  in  water.  Large  quantities  are  poisonous,  with 
symptoms  of  arsenical  poisoning. 

Medical  Properties  and  Action. — Subnitrate  of  bismuth  is 
sedative,  astringent  and  alterative.  Owing  to  the  formation 
of  a  sulphide,  it  coats  the  tongue  black,  and  its  continued  use 
may  give  rise  to  the  formation  of  a  bluish-red  line  on  the 
gums,  similar  to  that  resulting  from  the  use  of  lead,  except 
that  the  line  is  wider  and  deeper  in  color.  In  proper  doses,  it 
promotes  the  appetite  and  increases  the  digestive  power.  Being 
somewhat  astringent,  it  affects  the  intestinal  movements,  and 
can  be  detected  in. the  blood,  urine,  and  other  secretions. 

Therapeutic  f/j-^j-.-^Subnitrate  of  bismuth  is  employed  in 
atonic  dyspepsia,  gastric  irritations  (milder  forms),  pyrosis, 
gastrodynia,  ulcer  of  the  stomach,  diarrhoea  from  debility,  etc., 
chronic  laryngitis,  epilepsy,  ringworm  (in  form  of  an  ointment 
oj  to  lard  5J),  chronic  skin  diseases,  chlorosis,  when  iron  is  not 
tolerated,  etc.,  etc.  If  not  well  borne  by  the  stomach,  it  may 
be  combined  with  aromatic  powder,  or  if  alkalies  are  indicated, 
with  chalk  and  magnesia. 

Bismuthi  subnitras  is  also  employed  as  an  antiseptic  dress- 
ing for  wounds,  to  promote  primary  union.  The  subnitrate  is 
held  in  suspension  in  water,  in  the  proportion  of  10  per  cent., 
and  during  the  operation  the  wound  is,  from  time  to  time, 
sprinkled  with  the  solution,  and  afterward  sealed  with  a  bis- 


278  DENTAL  MEDICINE, 


muth  paste,  and  the  subsequent  dressings  made  in  the  same 
manner. 

Dose. — Of  subnitrate  of  bismuth,  grs.  v-x  to  5j,  in  powder 
or  emulsion. 

Dental  Uses. — Subnitrate  of  bismuth  is  a  valuable  internal 
remedy  in  aphthse,  mercurial  salivation,  painful  ulcers  of  the 
mucous  membrane  of  the  mouth,  vomiting,  cholera  infantum, 
and  diarrhoea  of  children  during  painful  dentition.  It  is  best 
given  in  milk,  and  before  meals. 

For  cancrum  oris,  after  using  a  disinfecting  solution  to 
cleanse  the  gangrenous  part,  the  topical  application  of  sub- 
nitrate of  bismuth,  every  three  hours,  corrects  the  fetor,  arrests 
the  progress  of  the  gangrene,  and  hastens  cicatrization. 

DENTAL  FORMULiE. 

JFor   Vomiting  and  Painful  Digestion  For  Diarrhea  of  Dentition, 

of  Teething  Children^  Acidity   and 

Pyrosis.  ^'   ^ismuthi  subnitrat  .    .  gr.lx 
^  Extract  rhei  fliiid    .    .  gtt.viij 

BARTHOLOW.  c-  u  r-z 

byrup  rubus     .    ,    .    .fgss 

R.    Bismuthi  subnitrat   .    .  ^iij  Elixir  aurantii  .    .    .    .fgss.     M. 

Acid  carbol gr.ij-gr.iv 

Mucil  acacia    •    •    •    •  §j  Signa.-A  teaspoonful  4  or  6  times  a 

A  it,       •  "  •••        -Kis  day.     Proper  feeding — barley  water, 

Aquae  menthce  pip  .    .  511J.       M.  -'  ^  ^  '  ' 

SIGNA.-A    tablespoonful   for    adults,  ™^'^^  ^""^  ^^^  ^^^^^-     Starchy  food 

and  proportionate  quantity  for  chil-  " 

dren  3  or  4  times  a  day. 

Pbr  Internal  Administration   to  Sup- 
For  Gangrene  of  Mouth  {Cancrum  port  the  Strength. 

Oris'). 

R-D-        ii  •      u   V       /        J  \  R.    Ouininse  sulphat  .    .    .  gr.iii  to  v 

.    Bismuthi  subnitras  (powd.).  ^_  _^        .   . 

Sign  A. — Applied  to  ulcerated  surface,  '  •  s   •  • 

and  covered  with  absorbent  cotton.  SiGNA. — Three  times  daily. 

Dermatol  is  a  basic  gallate  of  bismuth  in  the  form  of  a  fine 
saffron-yellow  powder,  odorless  and  innocuous.  It  is  insoluble 
in  water,  alcohol,  and  ether;  not  hydroscopic,  or  otherwise 
affected  by  air  or  light.  It  resembles  iodoform  in  appearance, 
and  possesses  astringent,  antiseptic,  and  desiccant  properties. 
It  is  used  externally  in  wounds,  ulcers,  and  inflammations  of 
mucous  membranes,  and  is  of  especial  value  in  lesions,  at- 
tended by  profuse  secretion,  as  eczema,  burns,  ulcers,  wounds. 


BROMIDES.  279 


and  diseases  of  the  eye  and  ear.     Internally,  it  is  employed  in 

diarrhcea,  etc.     As  an  antiseptic,  it  prevents  putrefaction,  and 

also  the  development  of  bacteria  when  used  as  a  i.io  per  cent. 

solution.     Dermatol  may  be  used  as  a  powder,  as  liquid  and 

paste,  in  emulsion  of  collodion,  glycerine,  and  essential  oils, 

and  as  an  ointment  with  lanolin    wax,  oxide    of   zinc,  and 

paraffin. 

BROMIDES. 

Bromides  are  diffusible  agents  which  rapidly  pass  into  the 
blood,  and  in  large  doses  can  be  detected  in  the  fceces  and 
intestinal  mucus,  owing  to  a  portion  of  the  agent  not  being 
absorbed.  They  depress  the  heart's  action,  and  also  respira- 
tion and  animal  temperature ;  in  some  cases  large  doses  may 
cause  transient  excitement,  giddiness  and  intoxication.  Mod- 
erate doses  have  a  tranquillizing  effect  and  refreshing  sleep, 
and  lower  the  sensibility  to  pain  and  irritation.  Their  im- 
moderate use  will  cause  paralysis  of  the  muscles,  and  a  con- 
dition known  as  bromisin,  the  symptoms  of  which  may  be 
extreme  pallor  and  anemia,  dilated  pupils,  slow  and  feeble 
action  of  the  heart,  breathlessness  and  quickened  pulse  on 
slight  exertion,  acne,  skin  eruption,  cool  extremities,  tremulous 
and  uncertain  movements,  want  of  tactile  feeling,  relaxation 
of  the  genitals,  dry  fauces,  difficult  deglutition,  and  weak 
mind. 

Ammonii  Bromidum — Bromide  of  Ammonium.  Formula. 
— NH^Br.  In  the  form  of  colorless,  transparent  crystals,  or  a 
white  granular  salt,  with  a  pungent,  saline  taste,  neutral  re- 
action, and  no  odor.  Ammonii  Bromidum  is  soluble  in  1.5 
parts  of  water,  in  150  parts  of  alcohol  at  60°  F.,  and  in  0.7 
part  of  boiling  water. 

Dose. — Gr.  x  to  5ss,  considerably  diluted. 

Calcii  Bromidum — Bromide  of  Calcium.  Formula. — 
CaBrg.  In  the  form  of  a  white  granular,  deliquescent  salt, 
with  a  pungent,  saline,  bitter  taste,  and  no  odor.  It  has  a 
neutral  reaction,  and  is  soluble  in  0.7  part  of  water,  and  in  i 
part  of  alcohol.  ^ 

Dose. — 3j  to  5ij. 


280  DENTAL  MEDICINE. 


LiTHii  Bromidum — Bromide  of  Lithium.  Formula. — 
LBr.  In  the  form  of  white,  granular,  deliquescent  salt,  with 
a  pungent,  bitter  taste,  and  a  neutral  reaction.  Quite  soluble 
in  water  and  alcohol. 

Dose. — Gr.  v  to  9ij. 

SoDii  Bromidum — Bromide  of  Sodium.  Formula. — NaBr. 
In  the  form  of  small,  colorless  crystals,  or  a  white  crystalline 
powder,  with  a  saline  taste,  neutral  reaction,  and  no  odor.  It 
is  soluble  in  1.6  parts  of  water,  and  in  200  parts  of  water  at 
60°  F. 

Dose. — 3j  to  5ii.  (See  Bromides  of  Potassium,  Camphor 
and  Ethyl.) 

Medical  Properties  and  Therapeutic  Uses. — The  bromides 
have  the  same  general  action  and  are  employed  for  the  same 
purposes.  The  bromide  of  lithium  is  considered  to  have  a 
more  hypnotic  influence  than  the  others ;  and  the  bromide  of 
sodium  is  generally  given  in  full  doses  ;  the  others  in  rather 
smaller  doses.  Prof  Bartholow  considers  the  bromide  of 
potassium  to  possess  more  toxic  power,  and  the  bromide  of 
sodium  the  least.  As  regards  their  influence  on  the  pulse, 
body,  head  and  respiration,  the  same  author  places  the  bro- 
mides in  the  following  order :  bromide  of  sodium,  bromide  of 
lithium,  bromide  of  potassium,  bromide  of  ammonium.  The 
bromides  are  eliminated  through  the  kidneys  chiefly ;  also 
through  the  mucous  membrane  of  fauces,  bronchi,  intestinal 
canal  and  the  skin  ;  several  days  being  required  for  their  dif- 
fusion outwardly  from  the  blood.  The  bromides  are  adminis- 
tered in  delirium  tremens,  insanity,  increased  action  of  the 
heart,  tetanus,  neuralgia,  epilepsy,  vaso-motor  disturbances, 
spasmodic  asthma,  abnormal  sexual  excitement,  nocturnal 
seminal  emissions,  vomiting  of  cerebral  congestion,  pregnancy 
and  sea-sickness,  cholera  infantum,  migraine,  strychnine-poi- 
soning, etc.,  etc.  Locally  in  pruritis,  prurigo,  eczema,  epithe- 
lioma, old  ulcers,  etc.  (For  Dental  Uses,  see  Bromide  of 
Potassium.) 


SULPHATE   OF   CADMIUM.  281 


BROMOL— TRI-BROM-PHENOL,  BROMO-PHENOL. 

Formula. — CeH2Br.3HO. 

Derivation. — Bromol  is  a  compound  of  bromide  and  carbolic 
acid.  It  is  in  the  form  of  soft,  white  needles,  and  is  prepared 
by  treating  phenol  or  carbolic  acid  with  an  excess  of  bromine 
in  aqueous  solution. 

Medical  Properties  and  Therapeutic  Uses. — Bromol  possesses 
strong  antiseptic  properties,  and  at  the  same  time  is  non-toxic. 
Rademaker  recommends  it  for  external  use,  either  dissolved 
in  olive  oil  (i  in  30)  or  mixed  with  vaseline  (4  in  40).  It  may, 
also  be  employed  in  the  form  of  powder  like  iodoform,  for 
sprinkling  in  wounds. 

It  is  also  used  internally  in  cholera  infantum,  typhoid  fever, 
etc.,  etc. 

Dose. — For  internal  administration,  the  dose  of  bromol  is 
from  2T  to  ^  grain. 

Dental  Uses. — The  uses  of  bromol  in  dental  practice  are  the 
same  as  iodol,  iodoform  and  other  antiseptics.  Good  results 
have  been  obtained  by  its  application  to  teeth  affected  with 
alveolar  abscess  and  gangrenous  pulps. 

CADMII  SULPHAS— SULPHATE  OF  CADMIUM. 

Formida. — 3CdS044-8H20. 

Derivation. — Sulphate  of  Cadmium  is  obtained  by  the  action 
of  nitric  acid,  diluted  with  distilled  water,  on  the  metal  cad- 
mium, the  solution  filtered  and  mixed  with  carbonate  of  soda, 
and  again  dissolved  in  sulphuric  acid  diluted  with  distilled 
water.  It  is  in  the  form  of  transparent,  colorless  crystals,  like 
those  of  sulphate  of  zinc. 

Medical  Properties  and  Action. — Sulphate  of  cadmium  is 
emetic  and  astringent,  and  closely  resembles  sulphate  of  zinc 
in  its  action,  but  is  stronger,  with  a  caustic  astringent  taste- 
It  is  very  nauseant  and  depresses  greatly.  Locally  it  is  an 
irritant  poison,  and  producfes  the  cerebro-spinal  symptoms  of 
coma  and  convulsions ;  it  is  not  administered  internally,  as 
the  preparations  of  zinc  are  preferable  for  such  use. 


282  DENTAL  MEDICINE. 


Therapeutic  Uses. — Sulphate  of  cadmium  is  employed  locally 
in  affections  of  the  eye,  being  valuable  as  a  collyrium  ;  it  has 
the  power  of  causing  absorption  of  opacities  of  the  cornea  to 
a  remarkable  degree.  It  is  also  used  as  an  injection  in  gon- 
orrhoea, in  the  strength  of  one  grain  to  four  ounces  of  water. 
It  is  also  used  in  the  form  of  ointment,  two  grains  with  four 
scruples  of  lard. 

Dental  Uses. — Sulphate  of  cadmium  has  been  employed  in 
ulcerations  of  mucous  membrane,  gangrene  of  the  mouth,  or 
cancrum  oris,  indolent  ulcers,  purulent  diseases  of  the  antrum, 
in  the  form  of  injections  and  lotions,  of  a  strength  about  one 
grain  of  the  sulphate  to  four  ounces  of  water. 

CALCII  HYPOPHOSPHIS— HYPOPHOSPHITE  OF  LIME. 

Formula. — CaH4(P02)2- 

Derivation. — The  salt,  Hypophosphite  of  Lime  is  obtained 
by  boiling  phosphorus  in  a  mixture  of  hydrate  of  lime  in  boil- 
ing water,  until  phosphoretted  hydrogen  escapes,  and  phos- 
phate and  hypophosphite  of  lime  are  formed  in  the  solution, 
which  is  then  filtered  and  evaporated  over  sulphuric  acid,  when 
the  salt  is  crystallized  out  in  the  form  of  white,  pearly  crystals, 
with  a  nauseous,  bitter  taste.  It  is  soluble  in  six  parts  of  water, 
but  is  insoluble  in  alcohol. 

Medical  Properties  and  Actio7t. — The  hypophosphite  of  lime, 
with  those  of  soda  and  potassa,  are  all  included  under  the 
term  "  alkaline  sulphites,"  Taken  internally,  they  are  readily 
absorbed,  and  are  partially  changed  in  the  system  into  sul- 
phates. They  combine  with  acids  to  form  salts,  and  they  dis- 
solve albumen,  and  increase  the  formation  of  saliva.  Being 
regarded  as  tonic,  alterative,  stimulant  and  nervine,  they  are 
employed  in  cases  of  debility,  more  especially  where  the  phos- 
phates are  deficient,  as  they  possess  the  therapeutic  properties 
of  phosphorus. 

Therapeutic  Uses. — The  different  sulphites  of  lime,  soda, 
and  potassa,  are  employed  in  intermittent  and  malarious  fevers, 
typhus  fever,  small-pox,  and  other  exanthematous  diseases, 
pyaemia,  dyspepsia,  neuralgia  with  nervous  depression,  anaemia, 


CALENDULA.  283 


for  which  affections  they  are  combined  with  iron  and  quinine ; 
diphtheria,  cystitis,  phthisis,  etc.,  etc.  Externally,  the  sulphites 
are  efficient  as  local  applications  (especially  the  sulphites  of 
soda),  in  gangrenous  and  other  ulcerations,  diseases  of  the 
skin,  etc.  One  or  two  ounces  to  the  pint  of  water  form  a 
stimulant  and  deodorizing  lotion,  which  is  promotive  of  healthy 
action. 

Dose. — Of  the  hypophosphites,  gr.  iij  to  gr.  xv,  three  times 
a  day  in  syrup. 

Dental  Uses. — The  hypophosphite  of  lime  is  the  most  eli- 
gible salt,  but  the  different  sulphites  are  often  administered 
together  in  the  form  of  a  syrup.  Where  there  is  nervous 
depression,  as  a  result  of  trigeminal  neuralgia,  the  hypo- 
phosphites  prove  serviceable.  In  the  case  of  delicate  chil- 
dren, where  there  is  reason  for  believing  the  phosphate  of 
lime,  or  the  lime  salts  generally  of   the  teeth,  are  deficient  in 

quantity. 

CALENDULA. 

MARIGOLD. 

Source. — Calendula  is  a  well-known  garden  plant,  some- 
times growing  wild,  with  a  peculiar  and  rather  disagreeable 
odor,  and  a  bitter,  rough,  saline  taste.  Both  the  leaves  and  the 
flowers  are  employed. 

Medical  Properties  and  Action. — It  is  slightly  stimulant, 
diaphoretic,  antispasmodic,  sudorific,  and  emmenagogue,  but 
is  seldom  used  internally.  It  contains  a  bitter  principle  known 
as  calendnlin. 

Therapeutic  Uses. — Calendula  has  been  employed  in  low 
forms  of  fevers,  scrofula,  jaundice,  amenorrhoea,  etc.  Ex- 
ternally it  is  used  in  the  form  of  tincture — Tinctnra  Calendula 
— in  its  full  strength  or  diluted,  and  is  very  serviceable  in 
exercising  a  curative  influence  in  the  treatment  of  incised 
wounds  and  contusions,  preventing  inflammation  and  suppura- 
tion. Some  writers  consider  it  to  be  unequaled  as  a  local 
application  after  surgical  operations,  as  it  promotes  union  by 
first  intention.  It  is  applied  as  a  lotion  on  lint.  It  is  also 
thought  to  be  a  preventive  against  gangrene  and  tetanus. 


284  DENTAL  MEDICINE. 


Dose. — Of  the  tincture  of  calendula,  f5j  to  f5ij- 
Dental  Uses. — Calendula,  in  the  form  of  tincture,  is  em- 
ployed in  dental  practice  as  an  application  to  wounded  or 
irritated  pulps  of  teeth,  when  partially  exposed ;  also  after  the 
extraction  of  teeth ;  wounds  about  the  mouth ;  and  in  such 
cases  it  proves  a  very  useful  remedy.  A  few  drops  added  to  a 
wine-glass  of  water  form  a  soothing  and  efficient  mouth-wash 
for  the  soreness  resulting  from  the  removal  of  salivary  cal- 
culus ;  also  useful  in  superficial  inflammations  of  the  mucous 
membrane  of  the  mouth,  etc. 

CALX— CALCIUM. 

LIME. 

Formula. — CaO. 

Derivation. — Lime  is  obtained  by  calcining  limestone  or 
chalk,  until  the  carbonic  acid  is  driven  off.  Lime  is  more 
soluble  in  cold  than  in  hot  water,  and  a  compound  of  lime  and 
sugar  is  more  soluble  in  water  than  pure  lime  alone.  Calcium 
is  the  metallic  base  of  lime. 

Medical  Properties  and  Action. — Quicklime  is  a  powerful 
escharotic  and  irritant. 

Liquor  Calcis — Lime  Water. — It  is  prepared  by  adding 
cold  water  to  freshly  slacked  lime,  and  the  clear  fluid  poured 
off". 

The  officinal  preparation  consists  of  four  troy  ounces  of 
saturated  solution  of  lime  in  eight  pints  of  distilled  water.  It 
is  a  colorless,  inodorous  liquid,  possessing  a'  disagreeable 
alkaline  taste. 

Exposure  to  the  air  causes  it  to  gradually  absorb  carbonic 
acid,  with  the  formation  of  insoluble  carbonate  of  lime,  and  it 
should  therefore  be  preserved  in  glass-stoppered  bottles.  The 
addition  of  liquorice  or  coriander  seed  will  disguise  its  taste. 

Medical  Properties  and  Action. — Lime  water  is  antacid, 
astringent,  antiseptic  and  detergent.  It  is  applicable  to  all 
cases  where  antacids  are  indicated,  and  where  an  astringent 
effect  is  not  objectionable. 

Therapeutic  Uses. — Lime  water  is  an  excellent  remedy  in 
gastric  irritation,  accompanied  with  nausea  and  vomiting  ;  also 


CALCIUM.  285 


in  dyspepsia,  attended  with  vomiting  of  food  ;  also  in  diarrhoea, 
after  the  inflammatory  action  has  been  reheved ;  also  in  glandu- 
lar affections,  as  an  alterative  resolvent.  Externally,  as  a  wash 
for  foul  ulcers,  diseases  of  the  skm,  and  as  an  injection  in  gleet 
and  leucorrhoea.  Atomized  inhalations  have  been  found  use- 
ful in  diphtheria  and  membranous  croup. 

Dose. — Of  lime  water,  f.jss  to  fgiij  or  iv,  several  times  a 
day.  It  may  be  mixed  with  an  equal  quantity  of  milk  for 
internal  use. 

Lime  Liniment — Liniinentum  6rt/m  (lime  water  foviij,  flax- 
seed oil  .^vij) — is  a  valuable  application  to  burns,  scalds  and 
in  small-pox. 

Dental  Uses. — In  dental  practice  lime  water  is  a  useful  agent 
in  the  form  of  a  gargle,  where  the  secretions  of  the  mouth  are 
viscid  and  fetid,  and  especially  where  the  teeth  are  soft  in 
structure  and  exceedingly  sensitive,  owing  to  the  condition  of 
the  oral  fluids,  and  especially  in  mucous  secretions,  which  act 
readily  on  teeth  deficient  in  earthy  constituents.  For  young 
patients,  the  use  of  lime  water  is  very  beneficial  to  the  teeth, 
owing  to  an  acid  condition  of  the  oral  fluids,  common  to  an 
early  period  of  life.  It  is  also  useful  where  the  teeth  are  very 
sensitive,  on  account  of  the  recession  of  the  gum  and  absorp- 
tion of  the  process. 

When  lime  water  is  applied  to  inflamed  mucous  membrane, 
or  to  suppurating  surfaces,  it  arrests  secretion.  It  is  also  useful 
in  sickness  and  irritability  of  the  stomach  during  dentition ; 
also  to  relieve  the  superficial  ulceration  of  the  mucous  mem- 
brane of  the  mouth,  caused  by  the  acid  eructations  attending 
dyspepsia,  in  the  proportion  of  one  part  of  lime  water  to  two 
or  three  of  milk. 

Syrup  of  the  Lacto-phosphate  of  Lime. — Sympiis  Calcii 
Lacto-pliospliatis — is  composed  of  precipitated  phosphate  of 
calcium,  22  parts;  lactic  acid,  33  parts;  orange-flower  water, 
80  parts ;  sugar,  600  parts  ;  hydrochloric  acid,  water  of  ammo- 
nia and  water,  each,  a  sufficient  quantity. 

Dose. — foj  to  f  5j. 

This  syrup  is  especially  useful  in  rickets,  mollities  ossium, 


286  DENTAL  MEDICINE. 


delayed  union  of  fractures,  caries  and  necrosis  in  bone,  anaemia 
of  nursing  mothers,  mammary  abscesses  or  boils,  carbuncles, 
chronic  bronchitis,  leucorrhoea,  early  decay  in  the  teeth  in 
children,  etc. 

CALX  CHLORATA— CHLORINATED  LIME. 
CHLORIDE  OF  LIME. 

Formula. — GaCl20. 

Derivation. — Chloride  of  Lime  is  obtained  by  passing  chlor- 
ine over  hydrate  of  lime  till  saturation  is  effected.  It  is  in  the 
form  of  a  grayish-white  substance,  either  in  powder  or  friable 
masses,  dry  or  but  slightly  moist.  It  is  readily  soluble  in 
water,  and  will  absorb  moisture  when  exposed  to  the  air.  It 
has  a  bitter,  caustic  taste,  and  a  slight  odor  of  chlorine. 

Medical  Properties  and  Action. — Chloride  of  lime  is  a  stimu- 
lant, deodorizer,  disinfectant,  antiseptic  and  bleaching  agent. 
In  small  doses  it  increases  the  action  of  the  secreting  organs, 
and  if  long  continued  it  acts  specifically  upon  the  lymphatic 
glandular  system,  causing  the  reduction  or  absorption  of  glan- 
dular and  other  tumors.  In  large  doses  it  acts  as  an  acro- 
narcotic  poison,  and  its  use  should  always  be  commenced  in 
small  doses,  carefully  increased,  and  discontinued  when  such 
symptoms  as  nausea,  vomiting  or  giddiness  appear.  It  is 
chiefly  used  as  a  disinfectant. 

Therapeutic  Uses. — Solutions  of  chlorinated  lime  are  em- 
ployed locally  in  scarlet  fever,  diphtheria,  aphthae,  gangrene; 
and  it  has  been  administered  internally  in  scrofula,  typhus, 
malignant  scarlet  fever,  syphilis,  etc. 

Dose. — Of  chloride  of  lime,  gr.  j  to  gr.  v,  in  solution,  several 
times  a  day.     As  a  wash,  i  part  dissolved  in  lOO  parts  of  water. 

Dental  Uses. — Chloride  of  lime  is  employed  in  dental  prac- 
tice in  the  treatment  of  cancrum  oris;  one  method  of  applica- 
tion being  the  introduction  of  the  dry  powder,  with  the  point 
of  the  finger,  to  the  ulcerated  surfaces,  and  the  mouth  well 
washed  out  immediately  afterward;  also,  in  the  form  of  a  gargle 
composed  of  i  part  of  powdered  chloride  of  lime  to  30  parts 
of  mucilage  and  15  parts  of  syrup.  Solutions  of  chloride  of 
lime  are  also  efficient  in  scorbutic  and  other  ulcerations  of  the 


CHLORINATED   LIME.  287 

mouth.     It  is  also  employed  to  correct  the  fetor  of  the  breath, 
in  the  form  of  a  mouth-wash,  prepared  as  a  weak  solution. 

One  of  the  most  important  uses  in  dental  practice  is  as  a 
bleaching  agent,  either  alone  or  in  combination  with  other 
substances,  to  restore  the  color  of  devitalized  teeth.  When 
chlorinated  lime  is  employed  for  bleaching  discolored  teeth,  a 
good  quality  should  be  obtained,  and  no  steel  instrument  used 
for  its  introduction;  wood  or  gold  instruments  are  to  be  pre- 
ferred, and  the  chloride  should  be  perfectly  dry,  and  have  been 
kept  so  from  the  time  it  was  made.  An  efficient  bleaching 
preparation  is  composed  of  equal  parts  of  dry  chlorinated  lime 
and  tartaric  acid,  mixing  them  together  dry,  and  adding  a  little 
of  the  acid  at  a  time.  When  prepared,  the  mixture  should  be 
kept  in  a  glass-stoppered  bottle.  For  bleaching  purposes, 
chlorinated  lime  is  also  combined  with  chloroform,  in  the  form 
of  a  thin  paste.  When  chlorinated  lime,  or  its  combinations, 
is  introduced  into  the  cavity  of  a  tooth,  it  should  be  secured 
by  a  temporary  filling  of  gutta  percha.  Hill's  Stopping,  or  one 
of  the  zinc  preparations,  and  be  secured  from  passing  beyond 
the  foramen  of  the  root,  by  a  filling  introduced  near  the  apex 
of  the  root.  More  than  one  application  may  be  required,  after 
which  the  cavity  should  be  thoroughly  cleansed,  and  a  tem- 
porary filling  of  the  whitest  shade  of  the  oxychloride  of  zinc 
filling  material  be  introduced  and  worn  for  some  time,  after 
which  a  more  durable  gold  filling  can  be  inserted. 

DENTAL    FORMULA. 
For  Gangrene  of  the  Mouth — Cati-  For  Fetor  of  the  Breath, 

crum   Oris.  Bartholow. 

Bartholow.  R.    Calc.  chlorat    .•  .    .    .  giij 

Aquae  destil gij 

R.    Calc.  chlorat    .    .    .    .  .^^ss  Alcoholis gij 

^^'^"^^g'"^^ oSS  01.  rosEe gtt.iv.     M. 

^q^^de^'i' 5»'ss.  M.       signa.-A  teaspoonful  in  a  tumblerful 

Signa. — To  be  used  as  a  lotion.  of  water;  used  as  a  gargle. 


CAMPHO-PHENIQUE. 
Derivation. — A  limpid,  volatile  fluid  with  a  hot,  aromatic 


Formula. — CgH^O. 


288  DENTAL   MEDICINE. 


taste,  and  the  odor  of  camphor,  obtained  from  the  chemical 
union  of  carboHc  acid  and  camphor.  Dissolve  9  parts  of  the 
acid  in  one  part  of  alcohol  and  mix  with  25  parts  of  camphor, 
forming  a  clear  oily  solution. 

Medical  Properties  mid  Therapeutic  Uses. — Campho-phe- 
nique  is  an  antiseptic,  local  anaesthetic,  germicide  and  parasi- 
ticide. It  is  also  non-irritant,  non-poisonous,  insoluble  in 
water  or  glycerine,  does  not  discolor  or  stain,  and  possesses 
an  agreeable  odor  and  taste.  It  prevents  suppuration  in  fresh 
wounds,  controls  it  in  wounds  in  all  stages,  and  as  a  local 
anaesthetic  obtunds  pain.  It  is  claimed  that  campho-phenique, 
pure,  is  equal  to  i  to  85  of  bichloride  of  mercury  which  is 
six  times  as  strong  as  it  can  be  used  even  on  the  unbroken 
skin,  and  about  25  times  as  strong  as  is  considered  safe  on 
cut  surfaces.  Campho-phenique  is  altogether  free  from  toxic 
or  caustic  properties,  and  is  one  of  the  safest  of  germicides ; 
it  also  maintains  an  unchanged  integrity,  and  is  well  adapted 
to  a  large  proportion  of  pathological  dental  cases.  It  should 
never  be  combined  with  water  or  glycerin,  but  it  will  mix  in 
all  proportions  with  alcohol,  ether,  chloroform,  and  all  fatty 
substances. 

Employed  as  an  antiseptic,  it  penetrates  the  tissue  as  rap- 
idly as  carbolic  acid,  and  also  slightly  hardens  the  tissue. 

Dental  Uses. — As  a  pulp-canal  dressing,  campho-phenique 
has  given  very  satisfactory  results  as  a  substitute  for  corrosive 
sublimate,  carbolic  acid,  creasote,  oil  of  cloves,  iodoform,  etc. 
If  thoroughly  applied  to  the  gum  or  injected  with  a  hypodermic 
syringe,  it  acts  as  an  efficient  local  anaesthetic,  and  causes  no 
constitutional  disturbance.  It  is  also  employed  as  an  obtun- 
der  of  sensitive  dentine,  and  relieves  the  pain  following  the 
extraction  of  abscessed  teeth  when  applied  on  a  pledget  of 
cotton  :  it  also  relieves  the  pain  attending  the  separation  of 
teeth,  and  irritation  of  the  dental  pulp.  It  is  also  used  as  the 
menstruum  for  the  arsenic  and  morphia  of  pulp  devitalizing 
preparations :  also  for  putrescent  pulps,  and  as  an  antiphlo- 
gistic in  the  earlier  stages  of  periodontitis.  It  will  mitigate 
the  pain  attending  the  induction  of  suppuration,  and  either  in 


CAMPHOR.  289 

full  strength  or  diluted,  give  satisfactory  results  when  injected 
into  fistulae.  It  is  also  useful  as  an  antiphlogistic  in  the  earlier 
stages  of  sthenic  pericementitis  applied  to  the  gum  on  small 
pads  of  linen  and  renewed.  Also  useful  in  eczema,  intolerable 
itchings,  burns,  sprains,  etc. 

DENTAL   FORMULA. 

For  Chapped  Hands.  Campho-Pheniqiie  Dentifrice. 

J.  W.   Downey,  M.  D.  g_    Campho-phenique    .    4  parts 

R .    Campho-phenique.  Myrrh 2  parts 

Oil  of  cade ^^  3J  Cuttle-fish  bone    .    .    4  parts 

Rose  cosmoline    .    .    .        ^j.  M.                Prepared  chalk    .    .  16  parts 

SiGNA. — Apply  frequently.  Lake  or  rose  pink    .     i  part. 

To  Sterilize  Instnnnents. — For  the  purpose  of  sterilizing  or 
disinfecting  instruments,  such  as  broaches,  nerve-canal  instru- 
ments, etc.,  a  solution  of  campho-phenique,  or  of  eugenol,  or 
of  oil  of  cassia,  or  oil  of  turpentine,  or  of  terpinol  may  be 
kept  in  a  small  large-mouthed  bottle  into  which  the  instru- 
ment may  be  dipped  before  using.  Bichloride  of  mercury 
injures  steel  instruments.  Dr.  W.  D.  Miller  recommends  a 
boiling  solution  of  bicarbonate  of  sodium  as  the  most  effec- 
tive sterilizer  (see  Dr.  Miller's  experiments  in  sterilizing  den- 
tal instruments  in  the  chapter  on  Antiseptics  in  Dental  Prac- 
tice). 

CAMPHORA— CAMPHOR. 

Formula. — CjoHigO. 

Source. — Camphor  is  a  concrete  substance  obtained  from 
the  camphor  laurel,  an  evergreen  tree  of  China,  Japan  and 
Formosa,  by  sublimation,  the  crude  gum  being  purified  by 
resublimation  with  quicklime.  Refined  camphor  is  in  the 
form  of  large  circular  cakes,  one  or  two  inches  thick,  and  has 
a  strong,  penetrating,  fragrant  odor,  and  a  bitter,  pungent 
taste,  attended  with  a  slight  sense  of  coolness.  It  is  white, 
pellucid,  and  somewhat  unctuous  to  the  touch. 

Medical  Properties  and  Action. — Camphor  is  anodyne,  stim- 
ulant, refrigerant,  diuretic  and  diaphoretic.  It  increases  the 
action  of  the  heart  and  arteries,  and  renders  the  pulse  softer 
19 


,290  DENTAL   MEDICINE. 


and  fuller ;  but  such  effects  are  very  transitory,  and  are  fol- 
lowed by  depression.  In  large,  but  not  over-doses,  it  allays 
pain  and  spasm,  and  induces  sleep.  In  over-doses,  it  excites 
narcotic  symptoms,  with  those  of  an  irritant  poison,  and  has 
proved  fatal.     It  acts  chiefly  on  the  nervous  system. 

Therapeutic  Uses. — Camphor  is  administered  in  fevers  of  an 
asthenic  type,  acute  inflammations,  inflammation  of  the  brain, 
delirium  tremens,  asthma,  rheumatic  and  nervous  headaches, 
diseases  of  the  heart,  hysteria,  dysentery,  diarrhoea,  cholera, 
etc.,  etc.  Externally  as  an  anodyne  in  rheumatism,  and  as  a 
discutient  in  chronic  inflammatory  affections ;  also,  the  powder 
as  a  snuff  in  coryza  and  influenza,  and  in  the  form  of  Camphor 
Liniment — Linimentimi  CatnpJiorcB — (camphor  i  part,  olive 
oil  4  parts). 

Camphor  Water. — Aqua  CainphorcE — (camphor  gr.  cxx, 
alcohol  TTLxl,  carbonate  of  magnesia  -Sss,  distilled  water  Oij). 

Soap  Liniment — LininientiLm  Saponis — (camphor  ,5iv,  oil  of 
rosemary,  fSss,  alcohol  Oij,  water  .3vj)  is  an  anodyne  and 
gentle  rubefacient  for  sprains,  rheumatic  and  gouty  pains. 

Spirit  of  Camphor — Spiritus  CamphorcB — (camphor  Siv, 
alcohol  Oij). 

Dose. — Of  camphor  in  substance,  gr.  ij  to  gr.  x,  in  form  of 
an  emulsion,  made  of  sugar,  gum  arable,  myrrh  and  water. 
Of  camphor  water  5j  to  Sj  ;  of  spirit  of  camphor,  TTLv  to  Hlxx. 

Dental  Uses. — In  dental  practice,  the  spirit  of  camphor  is 
locally  employed  to  allay  the  pain  arising  from  the  near  expo- 
sure of  the  pulps  of  teeth:  also  the  pain  of  sensitive  dentine, 
and  that  following  the  extraction  of  teeth  affected  with  peri- 
odontitis ;  also  to  arrest  the  hemorrhage  and  allay  the  pain  of 
wounded  pulps  of  teeth.  It  forms  an  efficient  anodyne  when 
in  the  form  of  a  strong  solution  of  camphor  in  chloroform. 
Camphor  has  also  been  employed  in  the  treatment  of  putres- 
cent pulps  of  teeth. 

Combined  with  creasote  or  carbolic  acid,  camphor  is 
thought  to  have  the  power  of  modifying  the  escharotic  action 
of  these  agents.  For  such  a  purpose,  20  grains  of  camphor 
are  combined  with  i  ounce  of  the  creasote  of  carbolic  acid. 


CAMPHOR.  291 


The  Oil  of  Camphor — Oleum  Camplwrce  is  preferred  by- 
some  to  answer  such  indications.  Camphor  also  forms  one 
of  the  ingredients  of  the  celluloid  base  of  artificial  teeth, 
which  is  composed  of  pyroxylin  lOO  parts,  camphor  40  parts, 
oxide  of  zinc  2  parts,  and  vermillion  0.6  part.  With  ether, 
camphor  is  also  used  as  a  local  anaesthetic.  A  cataplasm  of 
camphor,  morphia  and  flaxseed,  applied  to  the  cheek,  has 
been  used  for  the  relief  of  odontalgia. 

Phenol-Camphor  is  made  by  mixing  together  i  part  of 
carbolic  acid  and  3  parts  of  camphor.  After  24  hours  this 
becomes  a  liquid,  having  a  specific  gravity  of  990.  It  is  used 
with  oil  as  an  antiseptic,  and  in  the  form  of  spray  may  be 
applied  to  the  skin  as  a  local  anaesthetic.  It  is  also  employed 
to  disinfect  or  sterilize  surgical  and  dental  instruments,  and  on 
wool  and  gauze  for  dressing  wounds.  It  is  soluble  in  ether, 
alcohol  and  oils,  but  insoluble  in  water  or  glycerine.  Men- 
thol, cocaine,  salicylic  acid,  iodoform,  chloral  hydrate  and 
mercuric  chloride  are  soluble  in  phenol-camphor.  (See  Cam- 
pho-Phenigue.) 

Camphoid  is  composed  of  camphor  20  parts,  alcohol  20 
parts,  and  pyroxylin  i  part. 

Carbolated  Camphor  is  composed  of  carbolic  acid  (crystal) 
49^  parts,  and  gum  camphor  50^  parts. 

Nausea  from  Impression  Paking. — Dr.  A.  W.  McCandless 
recommends  a  gargle  of  camphor  water.  Should  this  fail,  a 
four  per  cent,  solution  of  cocaine  painted  over  surface  of  the 
tongue  and  palate  will  produce  the  desired  result  except  in 
very  obstinate  cases  ;  or  a  lozenge  composed  of  one-fourth 
grain  of  cocaine  allowed  to  dissolve  in  the  mouth  and  swal- 
lowed before  taking  the  impression. 

DENTAL    FORMULA. 

For  a  Local  Anasthetic ,  For  a  Local  Anceslhetic. 

R .    Pulv.  camphorse  ...    3  viij  R  •    Chloral, 

^ther.  sulph    ....  £3].        M.  Camphoras aa  3 

SiGNA.— Applied  to  the  gum  over  the  Morphias  sulph    ...        ^ss 

tooth  to  be  removed,  until   it   turns  Chloroformi ^j.     M. 

white  or  becomes  blanched.  SiGNA. — Apply    with    a     carael's-hair 


292  DENTAL  MEDICINE. 


brush,  allow  to  dry  and   reapply  as  For  Neuralgia. 

freely  as  is  necessary  to  render  part       ]J  •    Camphorse, 

insensible  to  pain.  Chlor.  hydratis  aa  equal  parts,    M. 

SiGNA. — Apply  as  a  lotion. 

For  a  Stitnulant  and  Anodyne  Lotion.  ^       ,r         /•  j   t^    .      j    -n   u. 

■'  ror  Neuralgia  and  Fxposed  Fulps. 

R .    Spiritus  rosmarini    .    .   g  j  R .    Camphorse 5  parts 

Camphorse ^j  Chlor.  hydratis    ...  2  parts 

Saponis  albas    .    .    .    .   ^iv.       M.  Cocaine  hydrochlor.    .  i  part.    M. 

SiGNA. — To  be  applied  as  a  lotion.  Signa. — Heat  to  boiling  point  of  water, 

when  it  liquefies ;  use  as  a  local  ap- 

For  a  Local  Ancesthetic.  plication. 

R .    Camphorse ^j  For  Pain  of  Tooth  Extraction. 

^thervel  chloroformi .  gij.       M.  R.    Camphor '2^] 

Signa. — Apply    with    a     camel's-hair  Chloroform f^ij        M. 

brush.  Signa. — Apply  on  cotton. 

For   Odontalgia. 

R .        Camphoras, 

Chloral  hydrat aagr.75 

Cocaine  hydrochlorat gi^-xv.         M. 

Signa. — Place  a  small  quantity  on  cotton  within  the  cavity. 

CAMPHORA  MONOBROMATA— MONOBROMATED  CAMPHOR. 

Formula. — CioH^gBrOa. 

Derivation. — Monobromated  Camphor  is  obtained  by  the 
action  of  bromine  on  camphor,  and  subsequent  purification 
with  animal  charcoal  and  repeated  crystallization.  It  is  a 
colorless,  crystalline  substance,  with  the  odor  of  camphor  and 
turpentine,  and  a  slightly  bitter  taste.  It  is  insoluble  in  water, 
but  soluble  in  alcohol  and  ether. 

Medical  Properties  and  Action. — It  produces  a  sedative  effect 
upon  the  circulatory  system,  and  especially  upon  the  cerebro- 
spinal nervous  system,  and  is  also  an  antispasmodic. 

Therapeutic  Uses. — Bromide  of  champhor  is  employed  as  a 
sedative  and  antispasmodic,  in  affections  of  the  nervous  sys- 
tem, and  where  camphor  is  indicated,  as  in  asthma,  neuralgia, 
hysteria,  delirium  tremens,  etc. 

Dose. — Of  bromide  of  camphor,  gr.  ij  to  gr.  x,  for  an 
adult. 

Dental  Uses. — In  dental  practice,  the  bromide  of  camphor 
is  employed  as  a  sedative  in  convulsions  of  dentition,  neural- 


CAPSICUM.  293 


gia,  etc.  For  children  suffering  from  the  convulsions  of  den- 
tition, gr.  j  of  the  bromide  of  camphor  in  acacia  mucilage, 
and  administered  every  hour,  has  been  very  serviceable  in 
arresting  the  paroxysms. 

CAPSICUM. 

CAYENNE  PEPPER. 

Source. — Capsicum  is  obtained  from  the  tropics  of  both 
hemispheres,  being  the  fruit  of  capsicum  annuum,  and  of 
other  species  of  capsicum.  The  crimson  or  yellow  pods  are 
dried  and  ground  to  powder,  which  has  a  bright  red  color, 
and  an  aromatic  smell,  with  a  bitter,  acrid,  burning  taste.  Its 
acrid,  pungent  qualities  are  due  to  a  peculiar  substance  in  the 
form  of  a  thick,  yellowish-red  fluid,  called  capsicine. 

Medical  Properties  and  Action. —  Capsicum  is  a  powerful 
stimulant,  producing,  when  small  doses  are  taken,  a  sensation 
of  warmth  in  the  stomach,  and  a  general  glow  over  the  body. 
It  promotes  the  digestive  process,  and  stimulates  the  circula- 
tion, and  also  the  genito-urinary  organs.  In  excessive  doses, 
capsicum  is  an  irritant  poison. 

Therapeutic  Uses. — It  is  employed  in  certain  forms  of  dys- 
pepsia, flatulent  colic,  scarlet  fever,  yellow  fever,  delirium 
tremens,  opium  habit,  etc.,  etc.  Externally  or  locally  as  a 
gargle,  in  putrid  or  other  forms  of  sore  throat,  chronic 
inflammation  of  the  fauces,  hoarseness  due  to  a  relaxed  con- 
dition of  the  vocal  cords,  relaxed  uvula,  and  in  poisoning 
by  opium,  belladonna  and  aconite,  it  has  proved  useful  as  a 
stimulant. 

Dose. — Of  powdered  capsicum,  gr.  v  to  gr.  x,  in  pill.  Of 
the  tincture  of  capsicum — Ti7ictura  Capsici  (capsicum  ,oj,  to 
diluted  alcohol  Oij — the  dose  is  TTLx  to  foj.  Of  the  infusion 
— Infustcni  Capsici  {cdL-^s'icnm.  .^ss;  boiling  water  Oj) — the  dose 
is  foss.     The  infusion  is  also  used  as  a  gargle. 

Dental  Uses. — In  dental  practice  the  tincture  of  capsicum  is 
serviceable  in  the  early  stages  of  acute  periodontitis ;  and 
also  where  it  is  necessary  to  hasten  suppuration  as  quickly 
as    possible,    on    account   of  the    increasing   severity   of  the 


294  DENTAL   MEDICINE. 


attack — a  solution  composed  of  gtt.  xxv,  in  a  glass  of  warm 
water,  of  which  a  mouthful  is  to  be  retained  for  some 
minutes. 

The  tincture  of  capsicum  is  also  useful  in  chronic  dental 
periodontitis,  to  resolve  the  inflammatory  products.  It  is 
also  used  to  stimulate  the  gums  and  mucous  membrane  of  the 
mouth  in  chronic  inflammation  and  ulceral/ion,  and  for  loose- 
ness of  the  teeth  as  a  result  of  salivation ;  also  in  cases  of 
turgidity  and  puffiness  of  the  gums.  It  is  often  serviceable  in 
chronic  alveolar  abscess  as  an  injection,  after  the  sac  has  been 
destroyed,  also  in  recession  of  the  gums  from  the  necks  of  the 
teeth,  for  the  purpose  of  stimulating  them.  A  few  drops 
added  to  a  solution  of  aromatic  sulphuric  acid  will  prove 
serviceable  in  caries  of  the  maxillary  bones,  and  in  disease  of 
the  antrum.  An  efficacious  stimulant  gargle  may  be  made  of 
the  tincture  of  capsicum  o^s,  to  rose  water  Sviij.  Dr.  Kirk 
recommends  capsicum  as  a  local  stimulant  and  counter- 
irritant  in  the  initial  stages  of  pericemental  inflammation  be- 
fore the  formation  of  pus  has  taken  place ;  in  cases  of  soreness 
about  roots  of  pulpless  teeth,  due  to  external  violence,  cold, 
etc.,  and  not  to  septic  irritation ;  for  relief  of  severe  neuralgias 
■following  the  extraction  of  lower  molar  teeth,  in  the  form  of  a 
cataplasm  applied  to  the  affected  side  of  the  face,  or  by  moist- 
ening a  piece  of  heavy  blotting  paper  and  applying  this  to  the 
side  of  face.  Dr.  J.  F.  Flagg  recommends  the  use  of  cap- 
sicum for  pericemental  inflammation  in  the  form  of  the 
powder  sewed  in  small  linen  bags  to  be  placed  in  the  mouth 
over  root  of  affected  tooth.  Dr.  Leffmann  recommends  small 
oval  disks  cut  from  capsicum  plaster  (Seabury  &  Johnson's), 
the  surface  of  which  has  been  lightly  anointed  with  the 
ethereal  extract,  or  oleoresin  of  capsicum,  which  can  be  nicely 
adapted  to  the  gum. 

CARBO    ANIMALIS    FURIFICATUS— PURIFIED    ANIMAL 
CHARCOAL. 

Source. — Animal  Charcoal,  called  "  bone  black,"  is  obtained 
by  exposing  bones  to  a  red  heat,  protected  from  the  air.  It 
consists  of  charcoal,  phosphate  and  carbonate  of  lime. 


CARVACROL.  295 


Purified  Animal  Charcoal. — Carbo  Animalis  Purificatus — 
is  obtained  by  digesting  bone  black  in  hydrochloric  acid  and 
water  to  a  moderate  heat,  when  it  is  dried  and  heated  to  red- 
ness in  a  covered  crucible. 

Properties  and  Action. — Animal  charcoal  is  an  absorbent, 
and  is  used  to  counteract  the  effects  of  poisonous  agents,  such 
as  the  alkaloids  and  acids. 

Dose. — Of  animal  charcoal  as  an  absorbent,  oss,  to  neutralize 
the  effects  of  each  grain  of  such  agents  and  strychnia  and 
morphia. 

CARBO    LIGNI— WOOD    CHARCOAL. 

Source. — Wood  Charcoal  is  obtained  by  subjecting  soft 
wood  to  a  red  heat  with  but  a  limited  supply  of  air,  by 
which  the  water,  etc.,  are  removed,  allowing  the  carbon  to 
remain. 

Properties  and  Action. — Wood  charcoal  is  antiseptic  and  dis- 
infectant and  detergent,  and  is  very  serviceable  in  correcting 
the  fetor  of  discharges  and  arresting  the  process  of  ulceration, 
especially  when  in  the  form  of  the  dry  powder,  or  mixed  with 
linseed  as  a  poultice. 

Therapeutic  Uses. — For  foul  and  gangrenous  ulcers,  gan- 
grene, phagedaena,  suppurating  surfaces,  cancerous  tumors, 
etc.,  etc. 

Dental  Uses. — The  powdered  charcoal  added  to  water,  in 
the  proportion  of  one  or  two  drachms  to  a  glass  of  water,  forms 
an  efficient  disinfectant  gargle  for  the  offensive  fetor  of  mercu- 
rial stomatitis;  also  useful  in  foul  and  gangrenous  ulcers  of  the 
mouth,  diseased  gums,  offensive  ulcerations,  offensive  fetor  of 
cancrum  oris,  etc.,  etc.  Notwithstanding  its  detergent  prop- 
erties, injury  results  from  its  use  as  a  dentifrice,  on  account  of 
its  tendency  to  cause  recession  of  the  gums  from  the  necks  of 

the  teeth. 

CARVACROL. 

Formula. — CjoHigOH. 

Source. — The  caraway  plant,  a  native  of  Europe. 

Derivation. — Carvacrol  is  a  product   of  the  essential  oil   of 

caraway,  which    is    obtained    from    the    seeds    of  the   plant. 


296  DENTAL   MEDICINE. 


Caraway — cariim — seeds  are  of  a  light  yellow  color,  with  a 
pleasant  aromatic  smell,  and  a  sweetish,  warm,  spicy  taste. 
They  are  stomachic  and  carminative,  and  are  occasionally  used 
in  flatulent  colic,  as  a  corrective  of  other  medicines.  The 
volatile  oil  of  caraway  is  most  employed  in  doses  of  gtt.  j  to 
gtt.  X.  Carvacrol  is  obtained  by  treating  the  oil  of  caraway 
with  iodine,  and  washing  the  product  with  potassa,  when  it  is 
mixed  with  carvene,  which  is  one  of  the  liquid  oils  of  caraway. 
Carvacrol  is  also  found  among  the  products  of  the  action  of 
iodine  on  camphor.  When  pure,  it  is  a  colorless,  viscid  oil, 
lighter  than  water,  in  which  it  is  nearly  insoluble.  Its  odor 
is  like  that  of  creasote,  and  its  taste  is  persistent,  strong  and 
acrid. 

Medical  Properties  and  Action. — Carvacrol  is  antiseptic,  car- 
minative, disinfectant  and  escharotic.  Combined,  it  forms  an 
efficient  gargle  in  inflammatory  conditions.  It  is  not  employed 
internally. 

Dental  Uses. — In  dental  practice,  carvacrol  has  been  em- 
ployed as  a  substitute  for  creasote,  carbolic  acid,  and  glycerole 
of  thymol,  in  the  treatment  of  odontalgia,  sensitive  dentine, 
alveolar  abscess,  and  as  an  antiseptic  in  the  pulp  canals  of 
teeth  ;  also  as  a  gargle  in  inflamed  and  ulcerated  conditions 
of  the  mucous  membrane  of  the  mouth,  tonsillitis,  etc.  Com- 
bined with  water,  in  the  proportion  of  3  drops  to  the  ounce,  it 
forms  an  efficient  gargle  in  stomatitis,  tonsillitis,  etc. ;  the 
strength  of  the  solution  may  be  increased,  when  a  more  pow- 
erful action  is  required.  It  is  also  employed  with  advantage 
in  sensitive  cavities  of  the  teeth,  in  operating  with  the  dental 
engine,  to  lessen  the  pain  from  friction  of  the  instrument.  As 
an  application  in  odontalgia,  from  an  exposed  and  irritable 
pulp,  it  affords  almost  instantaneous  relief  It  is  claimed  for 
carvacrol,  that  it  is  not  so  liable  to  cause  inflammation  as  crea- 
sote ;  especially  when  it  is  applied  through  the  pulp  canals. 
When  employed  to  obtund  the  sensitiveness  of  dentine,  it  is 
necessary  to  confine  it  in  the  cavity  of  the  tooth  for  a  few  days, 
by  means  of  a  temporary  filling  of  zinc  preparation,  as  it 
readily  dissolves  Hill's  Stopping  and  gutta  percha.     When  it 


CHINOLINE   OR   QUINOLINE.  297 

is  used  in  the  form  of  an  injection  in  alveolar  abscess,  a  sharp, 
burning  sensation  is  experienced  as  soon  as  it  reaches  the  seat 
of  the  affection,  when  the  crown  cavity  of  the  tooth  should  be 
immediately  closed. 

In  patients  of  a  scrofulous  diathesis,  it  is  necessary  to  exer- 
cise care  in  the  use  of  carvacrol.  When  applied  to  cavities 
before  the  introduction  of  the  filling,  and  to  exposed  pulps,  it 
is  introduced  on  a  pellet  of  cotton. 

CATECHU— CATECHU. 

Source. — Catechu  is  obtained  from  the  Acacia  catechu,  a 
large  tree  of  Pegu,  and  is  in  the  form  of  large,  hard,  and 
brittle  masses,  porous  on  fracture,  and  possessing  a  strong 
astringent  and  sweetish  taste. 

Medical  Properties  and  Therapeutic  Uses. — Catechu  is  a  valu- 
able astringent,  and  is  frequently  employed  in  diarrhoeas  of 
relaxation,  and  locally  in  gonorrhoea  or  leucorrhoea  in  the  form 
of  injections. 

Dose. — gr.  j  to  xxx. 

Tinctiira  Catechu  Composita. — Compound  Tincture  of  Cate- 
chu (catechu,  12 ;  cinnamon,  8,  in  diluted  alcohol,  q.  s.  ad  lOO 
parts). 

Dose. — nix-foj. 

Dental  Uses. — Catechu  is  a  valuable  local  astringent  in  the 
form  of  a  mouth-wash  for  spongy  gums,  and  relaxed  condition 
of  the  oral  mucous  membrane. 

DENTAL    FORMULA. 
For  Hemorrhage  after  Extraction  of  Teeth. 

Dr.  D.  a.  Rosenthal. 
(For  Internal  Administration.) 

R.        Tinct.  catechu f ^j 

Tinct.  digitalis f_^iss 

Extr.  ergotas  fl q.  s.  ad.  f3ij.  M. 

SiGNA. — A  dessertspoonful  every  2  hours. 

CHINOLINE   OR   QUINOLINE. 
Forimda. — C^  H^  N . 

Derivation. — Chinoline  was  first  obtained  from  coal  tar,  but 
afterward  from  the  cinchona  alkaloids.     More  recently  it  has 


298  DENTAL   MEDICINE. 


been  produced  by  the  action  of  glycerin  on  aniline,  or  nitro- 
benzol.  It  is  an  oily  liquid,  with  highly  refracting  property, 
and  it  combines  with  acids  to  form  salts.  The  salt,  Tartrate 
of  Chmolme,  is  not  so  deliquescent  as  the  other  salts  formed 
by  its  combination  with  acids,  and  is  in  the  form  of  lustrous 
crystals,  which  preserve  their  form  even  in  a  damp  atmosphere, 
although  they  are  soluble  in  water.  Chinoline  is  very  soluble 
in  alcohol  and  sparingly  soluble  in  water. 

Medical  Properties  ajid  Action. — Chinoline,  like  other  phenol 
derivatives,  such  as  resorcin,  hydroquinone,  etc.,  possesses  the 
power  to  lower  fever  heat,  but  does  not  affect  the  normal 
temperature. 

Therapeutic  Uses. — Like  resorcin,  chinoline  has  been  used 
in  intermittent  and  remittent  fevers  with  great  success  ;  also 
in  septic  disorders.  Topically,  chinoline  is  a  valuable  anti- 
septic, and  successfully  acts  upon  minute  organisms,  prevent- 
ing their  increase  and  septic  decomposition.  A  five  per  cent, 
solution  of  the  tartrate  of  chinoline,  the  salt  generally  em- 
ployed, has  been  applied  locally  in  diphtheria,  with  marked 
effect. 

Dose. — Of  chinoline,  gr.  v  to  xv. 

Dental  Uses. — Chinoline  is  used  in  dental  practice  as  an 
antiseptic,  belonging  to  the  same  class  as  resorcin,  the  salt 
tartrate  of  chinoline,  in  the  form  of  a  five  per  cent,  solution, 
being  preferable  for  local  application.  It  is  also  used  in  com- 
bination with  carbolic  acid,  for  application  on  cotton  to  an 
aching  cavity  from  which  a  tooth  has  been  extracted. 

CHLORIDE  OF  ALUMINIUM— ALUMINII  CHLORIDUM— 
CHLORALUM. 

Fonmila. — AlgClg. 

The  chloride  of  aluminium,  also  known  as  Chloraln.m,  is  pre- 
pared by  passing  chlorine,  at  high  temperatures,  over  a  mix- 
ture of  aluminium  and  charcoal.  By  placing  the  anhydrous 
chloride  of  aluminium  in  water,  it  is  converted  into  hydrated 
chloride.  It  is  said  to  be  quite  as  potent  as  chloride  of  zinc  or 
carbolic  acid,  and  devoid  of  poisonous  properties  and  unpleasant 
odor,  and  is   unirritating,  rendering  it  a  useful  antiseptic  and 


METHYL   CHLORIDE.  299 

disinfectant.  As  it  does  mot  cauterize,  it  is  especially  con- 
venient for  applications  to  the  mouth.  The  taste  is  sharply- 
saline,  like  that  of  alum,  and  its  action  closely  approximates 
that  of  chloride  of  zinc. 

In  dental  practice  it  has  been  used  in  the  treatment  of  peri- 
odontitis, alveolar  abscess,  caries  of  hopes,  putrid  pulps,  alve- 
olar pyorrhoea,  and  other  diseases  of  mucous  membrane. 

CHLORIDE   OF   MAGNESIA— MAGNESII    CHLORIDUM. 

Formula. — MgCl2+2Na. 

Chloride  of  Magnesia  is  prepared  by  evaporating  to  dryness 
a  concentrated  solution  of  muriate  of  magnesia,  the  chloride 
being  obtained  in  the  state  of  a  fused  hydrate.  It  is  a  bitter, 
very  deliquescent  salt,  which  acts  mildly  and  favorably  as  a 
purgative,  causing  a  flow  of  bile,  and  an  increase  of  appetite- 
On  account  of  its  extreme  deliquescence  the  liquid  form,  pre- 
pared by  dissolving  the  salt  in  its  weight  of  water,  is  preferred. 
The  dose,  diluted,  is  oSS  to  5J.  In  dental  practice  the  chloride 
and  hypochlorite  of  magnesia  have  been  employed  for  bleach- 
ing teeth. 

CHLORIDE   OF   TIN— STANNUM   CHLORIDUM. 

Formula. — SnCIg. 

Chloride  of  Tin  is  prepared  by  heating  tin  and  hydrochloric 
acid  together,  and  has  been  recommended  for  local  application 
in  purulent  discharges.  According  to  M.  Mallez,  chloride  of 
tin  has  a  direct  action  upon  purulent  secretions  from  mucous 
surfaces,  without  any  substitutive  action,  like  nitrate  of  silver 
for  instance.  Placed  in  contact  with  pus  globules,  under  the 
microscope,  these  are  seen  to  immediately  disappear.  In 
purulent  diseases  of  the  eye,  also,  it  was  successful.  A  solu- 
tion consisting  of  5ss  of  the  salt  in  fgiij  of  distilled  water,  is 
used  for  injections. 

CHLORIDE   OF   METHYL— METHYL   CHLORIDE. 

Formula. — CH3CI. 

Derivation. — Chloride  of  Methyl  is  produced  by  the  action 
of  chlorine  upon  marsh  gas ;  by  heating  together  common 
salt,  sulphuric  acid  and  methyl  alcohol ;  or  it  is  more  cheaply 


300  DENTAL  MEDICINE. 


manufactured  by  using  the  waste  products  of  beets  used  in 
the  manufacture  of  sugar.  It  is  the  chloride  of  a  hydrocar- 
bon in  the  form  of  methyl  chloride,  and  resembles  ether  in 
appearance,  taste  and  smell,  but  is  less  inflammable.  Chlo- 
ride of  Methyl  is  generally  employed  as  a  local  anaesthetic  in 
the  form  of  spray,  although  it  possesses  general  anaesthetic 
properties  also,  and  being  very  volatile  and  ether-like,  rapid 
evaporation  occurs  when  it  is  applied  over  an  affected  area. 
To  avoid  producing  inflammation  of  the  skin,  or  an  erythema 
in  persons  having  an  irritable  skin,  caution  is  necessary ;  and 
it  should  be  applied  over  as  many  nerve  filaments  as  possible. 
The  special  advantage  of  chloride  of  methyl  is  its  external 
application,  which  may  never  cause  more  than  a  temporary 
irritation  of  the  skin.  In  order  to  produce  local  anaesthesia 
with  this  agent,  M.  Bardet  proposes  before  spraying  a  surface 
with  it,  to  paint  it  with  glycerine,  the  revulsive  action  being 
less  severe,  and  the  glycerine  forming  a  surface  on  which  the 
drops  of  the  refrigerant  mixture  collect,  and  which  may  be 
readily  removed  after  the  desired  effect  has  been  produced; 
the  use  of  glycerine  is  also  said  to  prevent  the  dangers  of 
sloughing'  Dr.  Ch.  Bailly  recommends  the  following  method 
of  applying  this  agent  as  a  local  anaesthetic:  A  tampon  of  dry 
cotton  covered  with  dry  silk  is  sprayed  with  the  anaesthetic 
until  its  temperature  is  reduced  to  23^-55°  C.  below  zero. 
The  tampon  is  then  grasped  with  ebony  pincers  and  applied 
for  a  few  seconds  to  the  parts  to  be  anaesthetized,  and  perfect 
abolition  of  pain  at  once  secured.  Drs.  DaboU  and  Rhein 
recommend  chloride  of  methyl  as  an  application  for  trigeminal 
neuralgia,  giving  immediate  relief  by  paralyzing  the  small 
filaments  of  the  nerve.  The  spray  is  also  used  for  obtunding 
sensitive  dentine ;  it  produces  a  more  intense  cold  than  ether, 
and  with  less  pain,  its  obtunding  effect  lasting  a  longer  time. 

CHLORAL. 
CHLORAL  HYDRAS— HYDRATE  OF  CHLORAL. 

Fortnula. — C2HCI3O  HgO. 

Derivation. — Chloral  is  obtained  by  the  action  of  dry  chlo- 
rine  gas   on  absolute   alcohol,  and  is   purified  by  sulphuric 


CHLORAL.  301 

acid  and  a  small  quantity  of  lime ;  a  small  quantity  of  water 
converts  it  into  solid  crystalline  hydrate  of  chloral.  It  is  in 
the  form  of  a  snow-white,  crystalline  mass,  with  a  pungent 
odor  and  taste,  soluble  in  its  own  weight  of  distilled  water, 
and  very  soluble  in  alcohol.  When  heated,  it  fuses  and 
evaporates,  leaving  no  residue,  and  in  the  air  without  com- 
bustion. 

Medical  Properties  and  Action. — Hydrate  of  chloral  is  hyp- 
notic and  anaesthetic,  possessing  more  of  the  former  and  less 
of  the  latter  property  than  chloroform,  and,  unlike  chloroform, 
after  its  administration  there  is  no  elimination  by  the  breath 
or  urine.  It  diffuses  into  the  blood  rapidly,  causing  an  abun- 
dant flow  of  saliva,  and  a  cooling  sensation  in  the  stomach, 
followed  by  warmth.  Very  large  quantities  cause  a  high 
degree  of  gastric  irritation,  nausea  and  vomiting.  Taken  in 
moderate  quantity  it  stimulates  the  appetite,  and  produces 
muscular  relaxation.  It  is  uniformly  certain  in  its  action  as  a 
hypnotic,  has  no  depressing  influence,  and  does  not  cause 
constipation.  Administered  in  doses  of  gr.  x  to  gr.  xxx,  it 
causes  unconsciousness  to  pain,  and  a  profound  sleep,  lasting 
over  several  hours.  The  sleep  it  produces  is  quiet  and  gentle, 
and  induced  without  distress.  Liebreich  claims  to  have  pro- 
duced sleep  which  lasted  from  five  to  fifteen  hours,  with  from 
25  to  30  grains  of  hydrate  of  chloral. 

The  habitual  use  of  chloral  leads  to  a  disorder  which  is 
somewhat  similar  to  the  "  opium  habit,"  although  it  may  not 
be  as  persistent.  When  there  is  present  no  susceptibility  to 
its  hypnotic  action,  it  is  liable  to  cause  headache,  and  in  some 
cases,  a  delirious  excitement.  Its  hypnotic  action  is  immedi- 
ately preceded  by  a  stage  of  excitement,  generally  of  short 
duration,  which  is  followed  by  sudden  and  complete  sleep, 
very  much  like  natural  sleep,  calm,  dreamless  and  refreshing. 
It  differs  from  a  condition  of  narcotism  from  the  fact  that  the 
patient  can  be  easily  roused  to  partake  of  nourishment,  and 
will  readily  fall  asleep  again. 

There  are  no  unpleasant  after-effects  resulting  from  a  mod- 
erate dose  of  chloral,  differing  in  this  respect  from  morphine, 


302  DENTAL  MEDICINE. 


which  often  causes  headache,  faintness,  giddiness,  nausea  and 
constipation.  Chloral  is  not  capableof  producing  insensibility 
to  pain,  unless  the  quantity  administered  is  sufficient  to  sus- 
pend the  functions  of  the  cerebrum.  Great  care  is  necessary 
in  its  use  where  symptoms  of  pulmonary  disease,  fatty-heart 
or  degenerated  blood-vessels  are  apparent. 

When  a  proper  dose  is  administered  the  pupil  contracts 
slightly,  but  the  pulse  may  remain  unaltered  or  become 
slower,  and  the  respiration  unaffected.  When  an  improper  or 
dangerous  dose  is  taken,  profound  narcotism  ensues,  the 
respiration  becomes  slower,  the  pulse  weak,  rapid  and  irregu- 
lar, sensibility  is  lost,  all  reflex  movements  are  impossible,  and 
complete  muscular  relaxation  follows.  It  destroys  life  by  the 
suspension  of  the  functions  of  the  cerebrum,  and  by  paralysis 
of  the  respiratory  centre,  and  of  the  cardiac  ganglia;  also 
death  may  suddenly  follow  by  paralysis  of  the  heart,  in  cases 
of  fatty  degeneration,  and  the  lower  lobes  of  the  brain  remain 
unaffected.  The  paralytic  phenomena  caused  by  chloral  are 
due  to  its  direct  action  on  the  nervous  centres.  The  con- 
gestion of  the  meninges  of  the  brain  and  cord,  and  distention 
of  the  right  cavities  of  the  heart,  have  been  observed  after 
poisoning  by  chloral.  The  antidote  in  cases  of  poisoning  is 
strychnia,  and  the  same  treatment  as  in  opium  poisoning. 

Therapeutic  Uses. — The  most  important  uses  of  chloral  are 
in  diseases  of  the  nervous  system,  such  as  delirium  tremens, 
insanity,  tetanus,  acute  mania,  neuralgia,  chorea,  whooping 
cough,  and  in  rheumatism,  cholera  morbus,  sea-sickness,  etc., 
etc.  Having  no  direct  pain-relieving  power,  except  by  sus- 
pending the  functions  of  the  cerebrum  and  in  dangerous  doses, 
sleep  can  be  procured  and  pain  relieved  by  combining  the 
chloral  with  morphine,  when  it  is  very  effective. 

Dose. — Of  hydrate  of  chloral,  gr.  v  to  .3j  ;  but  it  must  be 
remembered  that  one  half  drachm  has  produced  poisonous 
symptoms.  Thirty  grains  of  hydrate  of  chloral  are  equal  in 
effect  to  gr.  j  of  opium.  For  adults,  if  short  intervals  of  sleep 
are  required,  from  gr.  xx  to  xxx  will  answer;  for  young 
children,  gr.  vij  is  the^'  dose  recommended.  Moderate  and 
frequently  repeated  doses  are  better  than  a  single  large  one. 


CHLORAL.  303 

Dental  Uses. — In  dental  practice,  the  hydrate  of  chloral,  in 
the  form  of  from  gr.  ss  to  gr.j,  is  applied  to  inflamed  pulps  for 
the  relief  of  odontalgia,  and  is  an  efficient  remedy;  it  is  also 
employed  for  the  relief  of  neuralgia  of  the  fifth  pair  of  nerves  ; 
as  a  stimulant  and  deodorizing  application  to  foul  and  fetid 
indolent  ulcers  ;  also  as  a  local  anaesthetic,  for  this  purpose 
being  combined  with  camphor  and  other  agents  (see  Aconite), 
(see  Camphor) ;  also  as  an  anodyne,  for  the  relief  of  the  pain 
of  periodontitis ;  and  as  an  injection,  for  alveolar  abscesses. 
It  is  also  used  as  a  lotion  (when  diluted  with  water)  for  in- 
flammations of  the  oral  mucous  membrane,  and  as  an  anti- 
septic (chloral,  5j;  aqua,  f5ij)  for  injecting  putrid  pulp-canals 
and  chronic  alveolar  abscesses.  Although  it  is  employed 
hypodermically,  yet  painful  phlegmons  have  resulted  from  its 
repeated  application. 

Chloral  Phenol. — When  chloral  is  combined  with  carbolic 
acid  it  liquefies,  and  a  preparation  composed  of  equal  parts  of 
phenol  and  chloral  is  used  for  odontalgia  as  well  as  for  its 
antiseptic  qualities.  Chloral  Phenol  is  a  colorless,  clear  liquid, 
soluble  in  alcohol,  acetic  acid,  amyl-alcohol,  chloroform,  carbon, 
glycerin  and  ether.  It  possesses  the  odor  and  taste  of  its 
constituents. 

Chloral  has  the  property,  when  rubbed  with  certain  bodies, 
such  as  camphor,  of  forming  therewith  syrup  liquids.  With 
phenol  (absolute  carbolic  acid)  it  also  liquefies,  and  a  prepara- 
tion composed  of  equal  parts  of  phenol  and  chloral  is  used  in 
medicine  for  allaying  toothache,  as  well  as  for  its  antiseptic 
properties.  A  recent  study  by  Fabini,  says  the  Chemist  and 
Druggist,  shows  that  chloral-phenol  possesses  the  odor  and 
taste  of  its  constituents,  and  when  applied  to  the  skin  produces 
inflammation  and  an  eruption  of  small  blisters.  It  is  a  colorless 
and  clear  liquid,  having  a  sp.  gr.  at  20°  C.  of  1.289,30  that  it 
sinks  in  anhydrous  glycerin.  It  is  soluble  in  alcohol,  acetic 
acid,  amyl-alcohol,chloroform,  carbon  bisulphide,  and  glycerin, 
as  well  as  in  ether  when  slightly  warmed.  It  is  only  partially 
soluble  in  petroleum  ether,  and  benzine  only  dissolves  a  little 
of  the  fluid,  and  what  is  dissolved  is  chloral-phenol.    Fabini 


304 


DENTAL   MEDICINE. 


tested  the  fluid  thoroughly.with  a  view  to  determining  whether 
it  is  a  mechanical  mixture,  and  it  behaved  in  every  way  towards 
re-agents  as  carbolic  acid  does,  while  with  sulphuric  acid  some 
of  the  chloral-phenol  yielded,  after  twenty-four  hours,  a  velvet- 
colored  plaster-like  mass,  which  consisted  of  meta-chloral  and 
phenol-sulphonic  acid.  There  seems  to  be  no  doubt,  therefore, 
that  chloral-phenol  is  a  mixture. 

This  preparation  should  not  be  confounded  with  the 
phenol  camphor  devised  by  Cockrane  (not  campho-ph6nique), 
and  made  by  mixing  together  i  part  of  carbolic  acid  and  3 
parts  of  camphor.  After  twenty-four  hours  this  becomes  a 
liquid,  having  a  sp.  gr.  of  990.  It  is  used  with  oil  as  an  anti- 
septic. As  a  spray  it  may  be  applied  to  the  skin  to  produce 
local  anaesthesia.  It  may  be  employed  for  disinfecting  surgical 
instruments,  and  upon  wool  and  gauze  for  wound  dressing. 
It  is  soluble  in  alcohol,  ether  and  oils,  but  not  in  water  or 
glycerin.  Menthol,  cocaine,  salicylic  acid,  iodoform,  chloral 
hydrate,  and  mercuric  chloride  are  soluble  in  phenol  camphor. 


DENTAL   FORMULAE. 


For  Foul  and  Fetid  Indolent  Ulcers. 

R .    Chloral  hydratis  .    .    .  gr.x 

Aquse  destillatae  .    .    .  f^j.       M. 
SiGNA. — To  be  applied  as  a  lotion. 

For  a  Local  Anasthetic. 

R .    Chloral  hydratis  .    .    .51] 

Pulveris  camphorse  .    •   ^ij.       M. 
SiGNA. — To  be  applied  as  an  obtund- 
ing  mixture,  by  means  of  an  appli- 
cator. 

For  Odontalgia  — Pulpitis. 
Flagg. 
R  .    Chloral  hydratis  ...    ^  iij 

Aquse  destill    .    .    .    .  f^^j.       M. 
SiGNA. — Apply  on  cotton. 
For  Foul  and  Fetid  Indolent  Ulcers. 
R .    Chloral  hydratis  .    .    .  3  ss 

Adipis §j.         M. 

SiGNA. — To  be  used  as  an  ointment. 


Local  AncEsthetic. 


Dr.  Storie. 


R 


Chloral  hydratis. 
Camphorse  (gum)   .  equal  parts. 
Rub  well  in  a  mortar  to  liquefaction 
and  add  gtt.v  of  carbolic  acid. 


For  a  Hypnotic. 

R .    Chloral  hydratis  .    .    .  5  ij 

Syrupi  aurantii  flores  .  g  iv 

Syrupi  tolutani    .    .    .  giv 

Aquse  destillatse  .    .    .  ^vj. 


M. 


SiGNA. — Dose  14  part,  largely  diluted. 

For  Neuralgia. 

R .    Chloral  hydratis  .    .  partes  3 

Camphorse    ....  partem  I.  M. 
SiGNA. — To  be   applied    over   seat   of 
pain. 


CHLORALAMID.  305 


For  a  Local  Anasthetic.  •  Local  AncEsthetic , 

B .     Chloral  hydratis,  R  •    Chloral  hydrat  .    .    .    .  gj 
Pulveris  camphor?e  .    .  aa  ^ij  ■^^^'  Menthse    ....   ^js 

Morphinje  sulph  .    .    ,        ^ss  Camphoras 3J 

Chloroformi     ....         5J.  M.  Morphin.  chlorhydrat  .  gr.ix.     M. 

SiGNA.— Apply  with  camel's-hair  brush ;  SiGNA.— Apply  a  small  quantity  upon  a 
dry  rapidly,  and  reapply.  pledget  of  cotton. 

Local  AncEsthetic . 

For  Neuralgia   and   Exposed  Pulps.  R .    Chloral  hydrate   .    .    .    gr.xx 

Mur.  cocaine    .    .    .    .    gr.vj 

B.    Chloral  hydratis  .    .    .  2  parts  Aqu^  destill |vj 

Camphorae        .    .    .    .  5  parts  ^^j^j  cz.xho\xdy    .    .    .  Ulij.      M. 

Cocaini  hydrochloratis  i  part.   M.  giGNA.-First  administer  i  drachm  of 

^  Heat  to  about  boiling  point  of  water  ^^^^^^^j^  ^p^^  ^^  ^^^^^j^  .  ^^^^  j^. 

"  ■  ject  a  small  quantity  of  the  mixture 

SiGNA. — Apply  locally.  ^  •   »         j      *u 

'^^  ■'  ■'  at  2  or  3  pomts  under  the  gum,  wait 

5  minutes,  and  then  operate. 

CHLORALAMIDE— CHLORALAMID. 

Formula.— ZQ\-Q  H  N  H . 

Derivation.— Vox'ixvQd.  by  the  combination  of  two  parts  of 
chloral  hydrate  and  one  part  of  formamide. 

Medical  Properties  and  Action. — Chloralamide  has  been  used 
with  good  results  in  hysteria,  chorea,  acute  mania,  monomania, 
typhoid  fever,  senility,  neurasthenia,  insomnia,  phthisis,  and 
diseases  not  attended  by  much  pain.  Mupfenbach,  from  a 
number  of  trials,  regards  it  a  useful  hypnotic,  but  with  the 
disadvantage  that  its  certainty  of  action  can  never  be  relied 
upon.  No  bad  effects  upon  the  circulation  or  in  the  feelings 
of  the  patient  have  been  observed  by  Reichmann,  although 
vomiting  may  occur.  According  to  Langaard,  this  drug  pro- 
duced a  decided  reduction  of  blood-pressure,  which  is  devel- 
oped more  gradually  and  is  later  in  making  its  appearance 
than  that  caused  by  chloral.  Compared  with  chloral,  chloral- 
amid  is  more  agreeable  to  the  taste,  and  more  easily  adminis- 
tered, rarely  causes  digestive  disorders,  does  not  depress  the 
heart  or  the  circulation,  seldom  produces  cerebral  disturbances. 
Compared  with  sulfonal,  it  is  more  prompt  in  its  action,  more 
soluble,  more  easily  administered,  the  sleep  it  produces  always 
passes  away  by  morning,  and  it  is  less  expensive. 
20 


306  DENTAL   MEDICINE, 

The  action  of  chloralamide  upon  digestion  is  as  follows: 

1.  Large  quantities  retarded  the  digestion  of  fibrin  in  the 
ratio  of  the  quantity  employed. 

2.  Small  quantities,  for  example,  up  to  0.02  gramme,  did 
not  have  any  marked  influence  either  in  accelerating  or  in 
delaying  the  digestion  of  fibrin. 

3.  Putrefaction  was  not  retarded  by  either  large  or  small 
quantities. 

Therapeutic  Uses. — The  most  important  uses  of  chloralamid 
are  in  diseases  of  the  nervous  system  not  attended  by  much 
pain,  such  as  have  before  been  enumerated. 

Dose. — Of  chloralamid,  gr.  30  to  45.  In  doses  of  twenty 
to  thirty  grains,  it  produces  better  effects  than  sulphonal,  but 
caution  in  the  use  of  this  drug  is  necessary  in  diseases  of  the 
heart,  on  account  of  its  causing  decided  reduction  of  blood- 
pressure. 

DENTAL    FORMULA. 
Foj-  Use  as  a  Hypnotic. 

R .        Chloralamid 5  iv 

Spts.  vini  gallici §  ij 

Curacao • ^ij.  M. 

SiGNA. — A  tablespoonful  (30  grains  chloralamid)  in  water  and  repeated  in 
4  hours  if  necessary. 

CHLORINIUM— CHLORINE. 

Symbol. — CI. 

Derivation. — Chlorine  is  a  greenish-colored  gas,  of  a  pene- 
trating and  suffocating  odor,  very  persistent  and  characteristic. 
It  is  soluble  in  water,  in  the  proportion  of  two  volumes  of  the 
gas  to  one  of  water,  and  is  a  supporter  of  combustion.  It  is 
generated  from  black  oxide  of  manganese,  hydrochloric  acid 
and  water,  is  an  active  irritant,  and,  when  breathed,  excites 
cough,  a  sense  of  suffocation  and  irritation  of  the  mucous 
membrane  of  the  nostrils  and  bronchial  tubes,  and,  when  con- 
siderable quantities  are  inhaled,  it  induces  spitting  of  blood, 
violent  pains,  and  sometimes  death.  It  is  a  deodorizer  and 
disinfectant,  and  has  been  used  to  destroy  disease  germs  and 
offensive  effluvia. 

Chlorine  Water. — Aqua  Chlori — Formula. — H20,2C1. — is 


CHLOROFORM.  307 


an  aqueous  solution  of  chlorine,  formed  by  passing  the  gas 
through  water.  It  is  a  greenish-yellow  liquid,  with  an  astrin- 
gent taste  and  the  suffocating  odor  of  chlorine  gas.  It  should 
be  kept  in  glass-stoppered  bottles,  in  a  cool  place,  and  protected 
from  the  light. 

Therapeutic  Uses. — Chlorine  water  is  used  internally  in  ma- 
lignant fevers,  such  as  scarlet  fever,  typhus,  and  in  diphtheria, 
aphthae,  gangrene,  syphilis,  diseases  of  the  liver,  skin  diseases, 
etc.;  and  as  an  antidote  for  hydrocyanic  acid.  The  poisonous 
effects  of  chlorine  gas  may  be  prevented  by  ammoniacal  gas. 
Albumen  is  the  antidote  for  chlorine  water,  given  freely,  in  the 
form  of  milk,  flour,  eggs,  etc. 

Dose. — Of  chlorine  water,  f5j  to  f5iv,  diluted. 

Dental  Uses. — Chlorine  water  is  employed  in  dental  practice 
as  a  local  application  in  gangrene  of  the  mouth  and  fauces, 
aphthae,  cancrum  oris,  and  fetor  of  the  breath.  Chlorine  gas 
has  been  employed  to  bleach  discolored  teeth,  care  being 
taken  that  it  reaches  no  other  part  than  the  cavity  of  the  tooth 
undergoing  such  treatment,  which  may  be  accomplished  by 
the  application  of  a  large  rubber  dam,  such  as  is  used  in  the 
operation  of  filling  teeth. 

DENTAL   FORMULA. 

For  Aphthce  and  Gangrene  of  the  For  Aphthce,  Stomatitis^  and  Cancrum 
Mouth.  Oris. 

R.    Aquse   chlori    .    .    .    .   gss  g.,    Liquoris  chlori 

Aquae  destillatse   .    .    .   giiiss  Mellis aa  gij,  M. 

Syrupi  simp 5ss.       M. 

,,  T-     u  J  1  SiGNA. — To  be  applied  as  a  lotion. 

biGNA. —  io   be   used  as   a   gargle  or  ^'^ 

lotion. 

For  Mercurial  Stomatitis. 
For  Fetor  of  the  Breath  and  an  An- 
tiseptic. R  •    Liquoris  chlori    .    .  part  j 

RT  •         •      1  1     •  „■  Aquce  destillatee  .    .  parts  viii.  M. 

.    Liquoris  chlori    .    .    .   ^iv  ^  ^  j-       • 

Mellis jiv  SiGNA. — To  be   used   as  a   gargle  for 

Aquae  destillatae  .    .    .  3  x.       M.  correcting  the  fetor,  and  diminishing 

SiGNA. — To  be  applied  as  a  gargle.  slightly  the  discharge. 

CHLOROFORMUM— CHLOROFORM. 
Formula. — CHCI3.     Sp.  gr.  L480. 
Derivation. — Chloroform  is  obtained  by  the  distillation  of 


308  DENTAL   MEDICINE. 


alcohol  with  chlorinated  lime.  The  form  for  medicinal  use 
{Chlorofon7mni  Purificatuni)  is  purified  by  agitation  with  sul- 
phuric acid,  which  frees  the  crude  chloroform  from  such  dele- 
terious agents  as  chlorinated  pyrogenous  oil ;  the  lighter  liquid 
is  then  separated,  and  carbonate  of  sodium,  previously  dis- 
solved in  water,  is  added  to  it.  The  mixture  is  then  agitated, 
the  chloroform  separated  from  the  supernatant  layer,  alcohol 
mixed  with  it,  and  lime  in  coarse  powder  added.  It  is  a  color- 
less, volatile  liquid,  of  an  agreeable  ethereal  odor,  and  a  hot, 
aromatic,  sweet  taste.  It  is  slightly  soluble  in  water,  and  dis- 
solves very  readily  in  alcohol  and  ether  in  all  proportions.  The 
boiling  point  is  142°  F.  The  purest  form  of  chloroform  has 
a  specific  gravity  of  1. 5022,  while  the  officinal  contains  a  little 
alcohol ;  it  is  a  terchloride  of  formyl.  The  purest  chloroform 
for  internal  use  is  obtained  from  the  hydrate  of  chloral.  The 
purity  of  chloroform  may  be  ascertained  by  agitating  it  with 
the  binitro-sulphuret  of  iron,  which  shows  the  presence  of 
alcohol  by  the  production  of  a  brown  tint;  chlorinated  pyro- 
genous oil  may  be  detected  and  removed  by  strong  sulphuric 
acid,  which  gives  the  solution  a  yellowish  or  reddish-brown 
color,  if  such  an  impurity  is  present. 

Medical  Properties  aitd  Action. — -Chloroform,  when  inhaled, 
is  an  anaesthetic;  and  when  administered  internally,  is  ano- 
dyne and  antispasmodic.  Its  effects  on  the  system  are  similar 
to  those  of  ether,  but  more  powerful  and  more  rapidly  pro- 
duced, and  it  requires  more  care  in  its  administration,  both  in- 
ternally and  by  inhalation  of  the  vapor.  Undiluted,  it  excites 
great  irritation  and  inflammation  of  the  mucous  membrane, 
and  the  vapor,  passing  through  the  fauces  in  quantity,  may 
enter  the  larynx  and  cause  great  heat,  inflammation  and  even 
oedema.  When  taken  internally  it  causes  a  feeling  of  warmth 
in  the  stomach,  followed  by  coldness,  similar  to  ether,  and  if 
taken  in  large  quantity,  undiluted,  it  acts  as  an  irritant  poison, 
inducing  violent  gastritis.  It  is  diffused  into  the  blood,  and 
affects  remote  parts.  It  increases  the  action  of  the  circula- 
tory system,  producing  excitement  of  the  brain,  followed  by  a 
deep,  heavy  sleep;  and  in  poisonous  doses,  stupor  and  insen- 


CHLOROFORM.  309 


sibility.  The  first  effect  of  the  inhalation  of  the  vapor  of 
chloroform  is  a  feeling  of  warmth  and  excitement  extending 
to  the  extremities,  which  is  succeeded  by  noises  in  the  ears 
and  a  vibratory  thrilling  and  benumbing  sensation  throughout 
the  body,  followed  by  a  loss  of  feeling,  motion  and  conscious- 
ness, with  general  paralysis  of  the  respiratory  muscles,  ster- 
torous breathing,  quick  pulse,  which  may  become  irregular 
and  weak,  owing  to  the  sedative  action  on  the  heart.  The 
pupils,  at  first  contracted,  become  dilated,  and  there  is  com- 
plete relaxation  of  the  muscular  system. 

The  following  are  the  practical  conclusions  of  the  second 
Hyderabad  Commission:  "The  recumbent  position  on  the 
back  and  absolute  freedom  of  respiration  are  essential.  If 
during  an  operation  this  position  cannot  be  from  any  cause 
maintained  during  the  administration  of  chloroform,  the  ut- 
most attention  to  the  respiration  is  necessary  to  prevent  as- 
phyxia or  an  overdose.  If  there  is  any  doubt  about  the  state 
of  respiration,  the  patient  should  be  at  once  restored  to  the 
recumbent  position  on  the  back.  To  insure  absolute  freedom 
of  respiration,  tight  clothing  of  every  kind,  either  on  the  neck, 
chest,  or  abdomen,  is  to  be  strictly  avoided ;  and  no  assistants 
or  bystanders  should  be  allowed  to  exert  pressure  on  any 
part  of  the  patient's  thorax  or  abdomen,  even  though  the  pa- 
tient be  struggling  violently.  If  struggling  does  occur,  it  is 
always  possible  to  hold  the  patient  down  by  the  shoulders, 
pelvis,  or  legs,  without  doing  anything  that  can  possibly  inter- 
fere with  the  free  movements  of  respiration.  An  apparatus  is 
not  essential,  and  should  not  be  used,  as,  being  made  to  fit 
the  face,  it  must  tend  to  produce  a  certain  amount  of  asphyxia, 
and  take  up  part  of  the  attention  required  elsewhere.  How- 
ever it  is  made,  it  introduces  an  element  of  danger  into  the 
administration.  A  convenient  form  of  inhaler  is  an  open  cone 
or  cap  with  a  little  absorbent  cotton  inside  at  the  apex.  At 
the  commencement  of  inhalation  care  should  be  taken  by  not 
holding  the  cap  very  close  over  the  mouth  and  nose,  to  avoid 
exciting,  struggling  or  holding  the  breath.  If  struggling  or 
holding  the  breath  does  occur,  great  care  is  necessary  to  avoid 


310  DENTAL  MEDICINE. 


an  over-dose  during  the  deep  inspirations  which  follow.  When 
quiet  breathing  ensues,  as  the  patient  begins  to  go  over,  there 
is  no  reason  why  the  inhaler  should  not  be  applied  close  to 
the  face ;  and  all  that  is  then  necessary  is  to  watch  the  cornea 
and  see  that  the  respiration  is  not  interfered  with. 

In  children,  crying  ensues  free  admission  of  chloroform 
into  the  lungs  ;  but  as  the  struggling  and  holding  the  breath 
can  hardly  be  avoided,  and  one  or  two  whiffs  of  chloroform 
may  be  sufficient  to  produce  complete  insensibility.  They 
should  always  be  allowed  to  inhale  a  little  fresh  air  during 
the  first  deep  inspirations  which  follow. 

In  struggling  persons,  but  especially  in  children,  it  is  es- 
sential to  remove  the  inhaler  after  the  first  or  second  deep 
inspiration,  as  enough  chloroform  may  have  been  inhaled 
to  produce  deep  anaesthesia,  and  this  may  only  appear,  or 
may  deepen,  after  the  chloroform  is  stopped.  Struggling  is 
best  avoided  in  adults  by  making  them  blow  out  hard  after 
each  inspiration  during  the  inhalation.  The  patient  is,  as  a 
rule,  ansesthetized  and  ready  for  the  operation  to  be  com- 
menced when  unconscious  winking  is  no  longer  produced 
by  touching  the  surface  of  the  eye  with  the  tip  of  the  finger. 

The  anaesthesia  should  never,  under  any  circumstances,  be 
pushed  until  respiration  stops ;  but  when  once  the  cornea  is 
insensitive,  the  patient  should  be  kept  gently  under  by  occa- 
sional inhalations,  and  not  be  allowed 'to  come  out  and  renew 
the  stage  of  struggling  and  resistance. 

As  a  rule  no  operation  should  be  commenced  till  the  patient 
is  fully  under  the  influence  of  the  anaesthetic,  so  as  to  avoid  all 
chances  of  death  from  surgical  shock  or  fright.  The  admin- 
istrator should  be  guided  as  to  the  effect  entirely  by  the  res- 
piration ;  and  his  only  object,  while  producing  anaesthesia,  is 
to  see  that  the  respiration  is  not  interfered  with.  If  possible 
the  patient's  chest  and  abdomen  should  be  exposed  during 
chloroform  inhalation,  so  that  the  respiratory  movements  can 
be  seen  by  the  administrator.  If  anything  interferes  with  the 
respiration  in  any  way,  however  slightly,  even  if  this  occurs 
at  the  commencement  of  the  administration,  if  breath  is  held, 


CHLOROFORM.  311 


or  if  there  is  stertor,  the  inhalation  should  be  stopped  till  the 
breathing  is  natural  again.  This  may  sometimes  create  de- 
lay and  inconvenience,  but  experience  will  make  any  admin- 
istrator so  familiar  with  the  respiratory  functions  under  chlo- 
roform, that  he  will  in  a  short  time  know  almost  by  intuition 
whether  anything  is  going  wrong,  and  be  able  to  put  it  right 
without  delay,  before  any  danger  arises.  If  the  breathing  be- 
comes embarrassed,  the  lower  jaw  should  be  pulled  or  pushed 
from  behind  the  angles,  forward,  so  that  the  lower  teeth  pro- 
trude in  front  of  the  upper.  This  raises  the  epiglottis  and 
frees  the  larynx.  At  the  same  time  it  is  well  to  assist  the 
respiration  artificially  till  the  embarrassment  passes  off.  If, 
by  any  accident  the  respiration  stops,  artificial  respiration 
should  be  commenced  at  once,  while  an  assistant  lowers  the 
head  and  draws  forward  the  tongue  with  catch  forceps,  by 
Howard's  method,  assisted  by  compression  and  relaxation  of 
the  thoracic  walls.  Artificial  respiration  should  be  continued 
till  there  is  no  doubt  whatever  that  natural  respiration  is  com- 
pletely re-established.  A  small  dose  of  morphia  may  be  in- 
jected subcutaneously  before  chloroform  inhalation,  as  it  helps 
to  keep  the  patient  in  a  state  of  anaesthesia  in  prolonged 
operation.  There  is  nothing  to  show  that  atropine  does  any 
good  in  connection  with  the  administration  of  chloroform, 
and  it  may  do  much  harm.  Alcohol  maybe  given  with  much 
advantage  before  operations  under  chloroform,  provided  it 
does  not  cause  excitement,  and  merely  has  the  effect  of  giving 
a  patient  confidence  and  steadying  the  circulation.  And  it  is 
the  opinion  of  the  Commission  that  "  if  the  above  rules  be 
followed,  chloroform  may  be  given  in  any  case  requiring  an 
operation,  with  perfect  ease  and  absolute  safety,  so  as  to  do 
good  without  the  risk  of  evil." 

[As  the  ph3'siological  actions  and  mode  of  administration 
of  chloroform  and  ether  are  similar,  the  reader  is  referred  to 
the  article  on  Sulphuric  Ether.] 

Therapeittic  Uses. — Besides  its  use  as  a  general  anaesthetic 
agent,  chloroform  is  internally  administered  in  substance,  as 
an   anodyne   and  antispasmodic,  for  non-inflammatory  affec- 


312  DENTAL  MEDICINE. 


tions,  such  as  nausea  and  vomiting,  sea-sickness,  sick  head- 
ache, flatulent  colic,  intermittent  fevers,  and  in  cholera,  for 
which  it  is  very  efficient.  The  vapor  is  employed  for  the  re- 
lief of  hay  asthma,  whooping  cough,  spasmodic  asthma,  and 
as  a  hypnotic  in  delirium  tremens,  and  as  an  injection  and 
lotion  in  neuralgia,  and  as  a  counter-irritant  or  vesicant,  for 
which  purposes  it  is  applied  to  the  skin,  and  evaporation  pre- 
vented. Great  care  is  necessary  in  the  administration  of 
chloroform  in  substance,  as  fatal  effects  have  followed  such 
use;  15  drops  have  destroyed  life.  Externally,  chloroform  is 
employed  as  a  stimulating  application  to  foul  and  indolent 
ulcers. 

Dr.  Spark  recommends  highly,  as  a  haemostatic  agent,  a 
solution  composed  of  chloroform  2  parts,  water  200  parts. 
He  claims  that  it  acts  with  a  rapidity  that  is  truly  marvelous, 
and  it  has  not  the  slightest  disagreeable  taste.  It  is  useful  in 
all  operations  upon  the  mouth  and  throat. 

Dose. — Of  chloroform,  TTLj  to  v,  in  sweetened  water  or  mu- 
cilage.    Dose  of  chloroform  for  inhalation,  5j  to  5ij- 

Spirit  of  Chloroform — Spiritus  Chloroforjni — is  composed 
of  chloroform,  Sj ;  diluted  alcohol,  Sij.  Dose  of  spirit  of  chlo- 
roform, 5ss  to  5j. 

Mixed  Chloroform  —  Morphia  Narcosis.  —  A  method 
practiced  by  Prof  Thiersch,  of  Leipsic,  succeeds  often  in  in- 
ducing a  perfect  analgesia  without  unconsciousness.  Morphine 
is'  first  hypodermically  injected,  and  in  from  five  to  seven 
minutes  afterwards  the  patient  is  very  lightly  chloroformed 
till  near  the  stage  of  excitement;  the  operation  is  performed; 
as  soon  as  pain  is  felt,  if  the  operation  is  a  prolonged  one,  a 
little  chloroform  is  added.  In  this  manner  not  the  tenth  part 
of  chloroform  is  needed,  and  it  is  claimed  that  the  operation  is 
as  painless  as  under  full  chloroform  narcosis,  and  there  is  no 
risk  of  danger  incurred.  Men  receive  one-half  a  grain  of 
morphine,  women  one-quarter  of  a  grain,  children  one-twelfth 
to  one-eighth  of  a  grain. 

Cocaine-Chloroform  Narcosis. — This  consists  essentially 
in  the  combined  use  of  cocaine  and  chloroform,  and  is  strongly 


CHLOROFORM.  313 


favored  by  Prof.  Obolinski,  of  Cracow,  who  injects  either  be- 
fore or  after  the  anaesthesia  is  obtained,  from  one  to  three  cen- 
tigrammes of  cocaine ;  or  he  injects  in  the  neighborhood  of 
the  seat  of  the  operation,  and  during  its  progress,  from  three 
to  seven  centigrammes.  Cocaine  is  used  on  the  ground  that 
it  is  a  complete  antagonist  of  chloroform  and  chloral ;  but  it  is 
not  so  regarded  by  others,  who  represent  it  to  be  a  general  ex- 
citor  of  the  central  nervous  gray  matter,  rather  than  a  direct 
and  powerful  stimulator  of  the  heart,  while  its  stimulant  effect 
upon  respiration  is  not  to  be  depended  upon.  Prof.  Obolin- 
ski claims  that  this  mixed  narcosis  secures  anaesthesia  with 
the  use  of  less  chloroform,  and  that  vomiting  is  prevented, 
and  there  are  fewer  disagreeable  after-effects. 

Dental  Uses. — Chloroform  is  employed  in  dental  practice  as 
a  general  anaesthetic,  also  as  a  local  anaesthetic,  for  which  pur- 
pose it  is  generally  combined  with  other  agents ;  as  an  ano- 
dyne and  antispasmodic,  either  locally  applied  or  the  vapor 
inhaled,  as  in  the  treatment  of  convulsions  of  dentition,  for 
which  it  is  a  very  efficient  remedy. 

DENTAL  FORMULA. 

For  Neuralgic  Affections.  Spirit!  lavandulae, 

R.    Chloroformi,  Pyrethri  (fluid  ext.)  .    .  aaf^j.  M. 

Spiriti  ammoniEe,  SiGNA. — Apply  for   I   or  2  minutes  to 

Tincturae  aconiti  .    .    .  aa  f ^j  gum  over  root   of  tooth   to   be    ex- 

Olei  ricini ^ij  tracted. 

Linimenti  saponis    .    .  fii.  M.                  ,,      ^7^7-        r,   ,^-^- 

^  ^■'                          ror  Odo7ttalgia — Pulpitts. 

SiGNA. — To  be  applied  as  a  liniment       n      /--t  1      r       •                      -  •• 

'^'^  K  .    Cliloroformi 5  ij 

over  seat  of  pain.  ai     1    i-                            t- 

^  Alcoholis 5J 

For  a  Local  Ancssthetic.  ^ther 5  ss 

R.    Chloroformi  purificati,  Camphorse  (pulv.)    .    .  |ss 

Tincture  aconiti,  Tinct.  opii |  ss 

Alcoholis aa  fgj  Oleum  caryophyUi  .    .  gj.        M. 

Morphinse  sulphat    .  gr.vi.  M.  o,„  ..        \      i              i.^              1   ^ 

^                ^  °     -"  hiGNA. — Apply  on  cotton  wool,  to  ex- 
SiGNA. — Apply  for  i  or  2  minutes   to                   ,      , 
'^^  -'                                                     posed  pulp, 
gum  over   root   of  tooth  to   be    ex- 
tracted -^'"'  Neuralgic  Affections  of  the  Teeth, 

For  a  Local  Ancssthetic.  R.    Chloroformi     ....  f^j  or  ij 

Von  Bonhorst.  Aquae Oj.  M. 

R.    Chloroformi,  SiGNA. — To  be   used   as   a  wash  or  a 
^theris  sulph.,  gargle. 


314 


DENTAL   MEDICINE. 


Fo7-  Neuralgic  Affections . 

R .    Chloroformi ^  ij 

Camphorse giss 

Olei  olivse gij.       M. 

SiGNA. — To  be  applied  as  a  liniment 
over  seat  of  pain. 

For  Odontalgia — Pulpitis. 

R.    Chloroformi, 

Tinct.  aconiti  .    .    .  aa  f^iij 
Tinct.   capsici  ...        f^j 
Tinct.  pyrethri 
Oleum  caryoph.   .    .aaf^ss 
Camphorse  (pulv.)   .  gss      M. 

SiGNA. — Apply  on  cotton  wool. 

For  an  Anodyne  Application  in  Neu- 
ralgia. 

R.    Chloroformi     .    .    .    .  f^^j 

Linimenti  camphorse   .  f^ij.       M. 
SiGNA. — To   be   applied   over  seat   of 

pain,  and  covered  with  oiled  silk,  to 

prevent  evaporation. 


R. 


For  Earache  of  Dentition. 
Chloroformi      .    .    .    .  ^j 


Olei  olivas ^j 

SiGNA. — Pour  from  gtt.  x  to  xx  in  ear, 
and  close  orifice  with  cotton. 

For  a  Local  AncBsthetic. 

R .    Chloroformi      ....  part  xx 

Acidi  acetici  (cryst.)    .  part  j.     M. 
SiGNA. — Apply  with  camel's-hair  brush, 
or  by  applicator. 

For  Excessive  Vomiting  and  Irritability 
during  Infantile  Diarrhoea. 

Dr.  Jas.  W.  White. 
R.    Spt.  chloroformi  .    .    .  ^^^j 
Creasote 1fT|^ij 


Vin.  ipecac "(^ 

Aquse  anisi  .    .  q.s.  ad  ^ij.        M. 
SiGNA. — A  teaspoonful  in  a  little  water 
for  a  child  I  year  old. 

Local  Ancssthetic. 


Dr.  Parson, 

R .    Chloroformi      .    . 

.    .  12  parts 

Tinct. 

aconiti  . 

.  12  parts 

Tinct. 

capsici  . 

,    .    4  parts 

Tinct, 

pyrethri 

.     2  parts 

Olei  caryophilli 

.    2  parts 

Camphorse    .    . 

.    2  parts 

Dissolve 

the  camphor 

in  the  chloro- 

form,  then 

add  the  oil  of  cloves,  then 

the  tinctures. 

For  Pain  after  Extraction. 
Dr.  T.  F.  Chupein. 


R .    Chloroformi 
Tinct.  aconiti 


aa  3J 


R.    Tinct.  camphora  .    ,    .  gj 

Chloroformi      .    .    ,    .  gij 
or 
R.    Morphinse grs.iij 

Tinct.  aconiti 

Chloroformi 

Alcohol aa  f  ^  siS 

For  Pain   after  Extraction. 
Dr.  D.  Genese. 
R  .    Chloroformi      ....  I  part 
Tinct.  pyrethri  ....  3  parts 

Local  Ancssthetic. 
Dr.  Frank  Abbott. 
R .    Chloroformi 

Tinct.  aconiti  rad.  .  aa  ^j 

Alcoholis      ^j 

Morphinse  sulph  .    .    .  grs.xii. 
SiGNA. — Used  locally. 


YELLOW   CINCHONA.  315 

CINCHONA   FLAVA— YELLOW   CINCHONA. 
CALISAYA  BARK— PERUVIAN   BARK. 

Source. — Cinchona  is  the  bark  of  the  tree  cinchona  cahsaya, 
which  grows  on  the  western  coast  of  South  America,  espe- 
cially of  Bolivia  and  Southern  Peru.  Different  varieties  are 
named,  according  to  their  color,  as  Cincliona  Flava,  yellow 
cinchona;  Cincliona  Pallida,  y^-aXo.  cinchona;  Cinchona  Rubra, 
red  cinchona.  The  medical  properties  of  these  barks  depend 
upon  the  alkaloids  they  contain  in  varying  proportions,  Quin- 
ina  being  the  most  important. 

Medical  Properties  and  Action. — The  yellow  bark  has  a 
much  more  bitter  taste  than  the  others,  but  is  comparatively 
free  from  acidity.  It  is  brownish  yellow,  the  powder  being  of 
an  orange  color,  and  it  contains  more  of  the  alkaloid  quinine 
than  the  other  barks. 

Cinchona  is  tonic,  astringent  and  antiperiodic,  and  the  dif- 
ferent varieties  owe  their  tonic  and  antiperiodic  properties  to 
the  alkaloids  quinina,  cinchonina  and  cinchonidina.  On  ac- 
count of  the  large  quantity  of  the  powdered  barks  it  is  neces- 
sary to  take  in  order  to  obtain  the  full  effects,  and  which  cause, 
in  some  cases,  derangement  of  the  stomach,  vomiting,  head- 
ache and  constipation,  the  alkaloid  quinine,  in  the  form  of 
sulphate  of  quinina,  is  preferable. 

Sulphate  of  Quinina — Qiiinince  Stdphas — is  prepared  by 
boiling  the  yellow  bark  in  water  acidulated  with  hydrochloric 
acid,  by  which  the  alkaloid  is  separated  from  its  combination 
with  kinic  and  other  acids,  to  form  a  soluble  hydrochlorate. 
This  salt  is  decomposed,  and  the  quinine  is  precipitated  by  the 
addition  of  lime,  and  afterwards  washed  in  boiling  alcohol. 

Sulphate  of  quinine  is  in  the  form  of  colorless,  very  light 
and  silky  crystals,  and  is  readily  soluble  in  alcohol,  and  in 
water  acidulated  with  sulphuric  acid.  It  is  insoluble  in  ether, 
and  requires  740  parts  of  cold,  or  30  parts  of  boiling  water  to 
entirely  dissolve  it. 

Cinchona  is  also  antiseptic,  as  the  powder  dusted  over  un- 
healthy wounds  will  arrest  putrefaction,  and  promote  healthy 


316  DENTAL  MEDICINE. 


cicatrization.  Quinina  will  destroy  minute  organisms,  and 
preserve  substances  from  decomposition.  The  cinchona  alka- 
loids are  readily  diffused  into  the  blood,  and  when  hypodermi- 
cally  injected,  are  absorbed  by  the  blood.  Cinchona  and  its 
alkaloids  increase  the  action  of  the  heart  slightly,  but  in  large 
doses  quinine  depresses  the  heart's  action  and  enfeebles  the 
pulse.  As  quinine  accumulates  in  the  brain,  a  sense  of  fullness 
in  the  head,  a  tightness  and  constriction  about  the  forehead,  a 
ringing  in  the  ears  {tnuiitus  aurium),  giddiness  and  vertigo  are 
experienced.  Deafness  also  occurs,  as  the  effect  of  consider- 
able doses,  and,  if  continued,  permanent  injury  may  result. 
Poisonous  doses  cause  intense  headache,  dilated  pupils,  de- 
lirium, conia  and  convulsions. 

Peruvian  bark  and  its  alkaloids  are  the  most  reliable  tonics 
and  antiperiodics. 

Therapeutic  Uses. — Cinchona,  and  its  alkaloid,  quinine,  are 
internally  employed  in  the  treatment  of  intermittent  fevers, 
and  also  other  fevers,  such  as  remittent,  typhus,  puerperal  and 
scarlet ;  also  in  influenza,  neuralgias  of  a  malarial  origin,  acute 
rheumatism,  phthisis,  advanced  stages  of  pneumonia  and  pleu- 
risy, erysipelas,  urticaria,  diseases  of  the  eye,  epilepsy,  gan- 
grene and  mortification,  scurvy,  pyaemia,  malarial  dysentery, 
passive  hemorrhages,  and  as  an  anthelmintic,  etc.,  etc. 

Dose. — Of  powdered  cinchona,  9j  to  5iij,  given  in  infusion 
of  liquorice ;  of  the  extract  of  cinchona,  gr.  j  to  gr.  x,  in  pill ; 
of  sulphate  of  quinine,  gr.  j  to  3j. 

Dental  Uses. — Cinchona  and  its  alkaloid,  quinine,  are  em- 
ployed in  dental  practice,  in  the  treatment  of  neuralgia  of  the 
fifth  pair  of  nerves,  when  due  to  malaria,  in  from  five  to  ten 
grain  doses  of  quinine ;  in  aphthous  ulcerations,  in  one  or 
two  grain  doses  every  tv/o  or  three  hours,  especially  when 
there  is  great  debility;  and  in  cancrum  oris;  also  in  the  form 
of  gargles  and  lotions,  in  gangrenous  ulcerations  of  the 
mouth.  Cinchona  is  also  employed  in  the  form  of  powder, 
as  an  ingredient  of  certain  dentifrices,  for  its.  tonic  and  anti- 
septic properties. 


CINNAMON. 


317 


R. 


R. 


Dentifrice. 

Pulv.  cinchonas  flav. 
Pulv.  saponis  cas.  albi 
Cretae  prep.  .  . 
Magnesise  calc. 
Otto  rosse  .  .  . 
Olei  caryophylli 

Dentifrice, 


DENTAL   FORMULA. 

Dentifrice. 

R .    Pulv.  cinchonse  flav 
Cretse  prep.  .    .    . 
Pulv.  myrrhse  .    . 
Pulv.  radicis  iridis 


C^iv 
^iv 

gtt.viij 
gtt.vj. 


ID.SS 

ib.ss 


M. 


M. 


R. 


For  Ulceration  of  Gums. 
Pulv.  cinchonge    .    .    .   ^ij 


Pulv.  cinchonse  flav.       ^iij 

Cretse  prep ^  iij 

Sacchari  albi  .  .  .  .  §j 
Pulv.  cinnamomi  .  .  .  ^j 
Pulv.  saponis  cas.  albi.  ^  ij 
Pulv.  myrrhse  .    ,    .    .  3J. 


M. 


Cupri  sulph gr.x 

Acacias  (pulv.)     .    .    .  3J 

Mellis ^ij 

Aquas  purse §iij.      M. 

SiGNA. — Apply    with    a    camel's -hair 

brush  to  ulcerated  surface  of  mucous 

membrane. 


For  a   Wash   after  the  Extraction  of 

For  Mercurial  Stomatitis. 

Teeth. 

Garrettson 

R.    CinchonEe  (decoct.)    .  f^ij 

R .    Tinct.  cinchonae  .    . 
Potassas  chloratis  .    . 
Sodsebibor 

^ss 
3ij 

Aluminae ^ij 

Infus.  rosse f§ij.      M. 

SiGNA. — Use  as  a  gargle. 

Aluminis  pulv.     .    . 

3>J 

For  Digestive  Stimulation  in  Pyorrhoea 

Potassas  permanganati 

i  gr.xxv 

Alveolar  is. 

Aquje  colonise  .    .    . 

IJ 

Dr.  Chas.  B.  Atkinson. 

Tinct.  myrrhse     .    . 

SJ 

R.    Cinchonidinse  sulph.    .  ^ss 

Tinct.   capsici  .    .    . 

3J 

Acid,  sulph.  arom.  .    .  ^ij 

Tinct.  kramerise  .    . 

I) 

Alcohol  (95  per  cent.)  5iij 

Aquee 

gviij.    M. 

Aquse  dest.  q.  s.  ad.    .   ^  xv.      M. 

SiGNA. — Use  as  a  gargle. 

SiGNA. — One  teaspoonful  ter  die. 

CINNAMOMUM— CINNAMON. 
CASSIA   BARK. 

Source. — The  best  variety  of  cinnamon  is  obtained  from 
Ceylon,  and  is  the  prepared  bark  of  a  tree  of  the  natural  order 
Laitracece. 

It  is  in  the  form  of  long,  cylindrical  pieces,  thin,  smooth, 
and  of  a  yellow-brown  color,  with  a  fragrant  odor,  and  a 
warm,  sweetish,  aromatic  and  slightly  astringent  taste.  It 
contains  a  volatile  oil,  a  slight  amount  of  tannic  acid,  an  acid 
peculiar  to  itself,  cuDiamic  acid,  mucilage,  lignin,  etc. 


318  DENTAL  MEDICINE. 


Medical  Properties  and  Action. — Cinnamon  is  an  aromatic 
stimulant  and  astringent,  being  more  powerful  as  a  local  than 
as  a  general  stimulant.  Its  medicinal  virtues  principally  reside 
in  a  volatile  oil,  oleum  cinnamomi. 

Therapetitic  Uses. — Cinnamon  is  chiefly  used  as  an  adjunct 
to  other  medicines,  being  seldom  prescribed  alone,  though  it 
is  capable  of  allaying  nausea  and  vomiting,  and  also  relieving 
flatulence.  Combined  with  chalk  and  with  other  astringents, 
it  is  well  adapted  for  the  treatment  of  diarrhoea.  A  strong 
decoction  of  cinnamon  made  by  boiling  one  pound  of  the 
Ceylon  sticks  in  a  closed  vessel  for  eight  hours  in  three  pints  of 
water  until  the  quantity  is  reduced  to  one  pint,  is  recommended 
by  Dr.  Carne  Ross  for  the  pain  of  cancer.  Dose  is  one-half 
pint  taken  during  the  24  hours  soon  after  meals. 

Dose. — Of  cinnamon,  gr.  x  to  5ss  of  the  powder;  of  the 
tincture,  the  dose  is  f5j  to  fSiij- 

Oil  of  Cinnamon — Oleum  Cinnamomi — is  obtained  by  dis- 
tillation, and  when  fresh,  is  of  a  light  yellow  color,  which 
becomes  deeper  by  age,  and  ultimately  red.  It  has  an  exces- 
sively hot,  pui^gent  taste.  It  is  often  employed  to  conceal  the 
taste  of  other  medicines,  and  is  a  powerful  local  stimulant. 
Large  doses  of  the  oil  of  cinnamon  are  poisonous,  producing 
an  inflamed  and  corroded  condition  of  the  gastric  and  intesti- 
nal mucous  membrane. 

Dose. — Of  the  oil  of  cinnamon,  gtt.  j  or  gtt.  ij,  administered 
in  the  form  of  an  emulsion. 

Oil  of  Cassia. — The  oil  of  cassia  is  prepared  from  the  bud, 
and  the  oil  of  cinnamon  from  the  bark  of  the  same  order  of 
tree  Laurace(E.  The  oil  of  cassia  is  preferred  by  many  to  the 
oil  of  cinnamon.  (See  Essential  Oils,  also  Antiseptics  in 
Dental  Practice.) 

Cinnamon  water — Aqua  Cinnamomi — (cinnamon,  carbonate 
of  magnesia  and  distilled  water),  is  used  as  a  vehicle  for  other 
medicines. 

Spirit  of  cinnamon — Spiritus  Cinnamomi — (oil  of  cinnamon, 
I  part,  stronger  alcohol  1 5  parts).     Dose,  gtt.  x  to  gtt.  xx. 

Dental  Uses. — Cinnamon,  in  the  form  of  powder,  is  employed 


COCAINE.  819 

as  an  ingredient  of  dentifrices,  for  its  stimulant,  astringent  and 
aromatic  properties.  Oil  of  cinnamon  is  also  employed  as 
an  ingredient  of  dentifrices,  for  its  stimulant,  astringent  and 
aromatic  properties,  and  for  the  relief  of  odontalgia.  One 
drop  applied  to  an  inflamed  dental  pulp  will  afford  temporary 
relief;  it  is,  also,  combined  with  iodoform,  in  the  treatment 
of  alveolar  pyorrhoea.  M.  Chamberland  asserts  that  no  liv- 
ing germ  of  disease  can  resist  the  antiseptic  power  of  essence 
of  cinnamon  for  more  than  a  few  hours.  It  is  said  to  destroy 
microbes  as  effectively,  if  not  as  rapidly,  as  corrosive  subli- 
mate. 

DENTAL   FORMULA. 
For  Alveolar  Pyorrhcea.  For  Alveolar    Pyorrhea,  Abscess,  etc. 

Dr.  a.  W.  Harlan.  '^^-  Black's  i.  2.  3.  Mlxture. 

R  .    Oil  of  cinnamon  ...  I  part 

R.    Oil  of  cassia    .    .    .    .  TTI -^ij  n    \^  ^■        -a  1        *  ^     „ 

,  „  Carbolic  acid  (cryst.) .  2  parts 

Distilled  water    .    .    .   Sxvi.  ^.,    r        ui,     •  ^        ^     -kk 

^      ■'  Oil  of  gaulthena  ...  3  parts.  M. 

Agitate  from  time  to  time  for  a  few 

days  at  a  temperature  of  70°  F.,  or  ^'^  Sterilize  Softened  Dentine  over  a 
upward,  and  to  each  ounce  of  the  above  ^  early  Exposed  Pulp. 

add:  ]3r.  H.  A.  Smith. 

Officinal  dilute  sulphuric  acid  ITI  v.       r>      /~>-i    r 

'^  ^  K .    Oil  01  cassia    ....  2  parts 

Carbolic  acid   ....  I  part 

SiGNA. — After    injecting     peroxide    of  Oil  of  cloves    ....  3  parts.  M. 

sodium,  inject  the  above  slowly.  Insert  permanent  filling  at  once. 

COCAINE. 

Source. — Cocaine  is  the  alkaloid  obtained  from  the  leaves 
of  the  ErytJiroxylon  Coca,  a  shrub  indigenous  to  certain  parts 
of  South  America,  as  Peru  and  Chili.  The  leaves  resemble 
those  of  Chinese  tea,  and  in  the  preparation  of  the  alkaloid  it 
is  necessary  that  they  should  be  of  the  best  quality,  which 
depends  upon  their  being  gathered  at  a  proper  time,  carefully 
dried  and  not  injured  by  age  or  by  exposure  to  the  air,  as 
moisture  deprives  them  of  all  value.  Cocaine  being  extremely 
susceptible  to  the  influence  of  acids,  A.  Castaing,  Ph.G.,  de- 
vised a  method  by  which  one  grain  of  cocaine  can  be  extracted 
from  four  hundred  and  eighty  grains  of  the  leaves  without 
using  acidulated  fluids,  which  is  as  follows :  "  On  one  part  by 


320  DENTAL   MEDICINE. 


weight  of  coca  leaves  pour  eight  parts  of  boihng  w^ter,  and 
let  them  steep  for  half  an  hour  in  a  closed  vessel,  in  a  water 
bath;  pour  the  whole  into  a  percolator,  and  when  all  the 
liquid  part  is  strained  off,  continue  the  exhaustion  of  the 
leaves  by  pouring  on  them  eight  parts  of  alcohol,  at  85°;  mix 
the  two  liquids  and  precipitate  them  by  means  of  acetate  of 
lead,  draw  off  with  a  siphon,  and  then  add  sulphate  of  sodium 
to  remove  the  salts  of  lead;  filter  and  evaporate,  at  a  gentle 
heat,  until  the  liquid  has  attained  the  consistence  of  syrup; 
treat  the  whole  with  water,  to  separate  the  resinous  part,  and 
then  precipitate  with  carbonate  of  sodium;  the  precipitate  is 
then  to  be  exhausted  by  sulphuric  ether,  and  the  ethereal 
solution,  after  the  ether  is  distilled,  is  exposed  to  the  air  until 
every  trace  of  ether  has  completely  disappeared ;  by  this  means 
is  obtained  a  crystallized  residue,  of  a  brownish-yellow  color, 
and  of  a  disagreeable  smell.  This  is  impure  cocaine.  The 
coloring  matter  is  removed  by  washing  once  or  twice  with 
cold  alcohol.  The  cocaine  thus  purified,  appears  in  the  form 
of  transparent  prisms,  without  smell,  bitter  to  the  taste,  solu- 
ble in  seven  hundred  parts  of  cold  water,  more  soluble  in 
alcohol,  and  entirely  soluble  in  ether.  The  solution  has  an 
alkaline  reaction,  and,  when  applied  to  the  tongue,  it  imparts 
a  bitter  taste,  and  a  certain  insensibility,  followed  by  a  slight 
sensation  of  cold,  recalling  the  effect  of  ether  spray  upon  the 
epidermis.  Heated  to  208°  F.,  the  cocaine  becomes  liquid, 
and  under  the  influence  of  cold,  it  becomes  a  transparent 
mass,  which  gradually  assumes  a  crystalline  form.  If  it  be 
exposed  to  a  higher  heat  than  208°  F.,  cocaine  changes  its 
color  and  decomposes.  It  is  inflammable,  and  burns  with  a 
brilliant  flame,  leaving  an  ash.  It  forms  soluble  salts  with 
acids  (its  hydrochlorate  is  one  of  the  best),  and  all  these  salts 
are  more  bitter  than  the  alkaloid.  It  is  a  compound  of  carbon, 
hydrogen,  nitrogen  and  oxygen.  Pure  cocaine  is  in  the  form 
of  colorless,  transparent  prisms,  without  odor,  but  with  a 
slight  bitter  taste.  The  chemical  composition  of  the  alkaloid 
is  C17H21NO4;  its  reaction  is  strongly  alkaline. 

The  two  forms  in  which  cocaine  is  most  generally  used  are 


COCAINE.  321 

the  hydrochlorate  or  muriate  and  the  oleate.  The  hydrochlor- 
ate  of  cocaine  is  generally  employed  in  surgery,  and  is  in  the 
form  of  a  white  crystalline  powder,  which  is  sparingly  soluble 
in  water,  but  readily  soluble  in  alcohol,  ether,  oil  and  vaseline. 
At  first  a  2  per  cent,  solution  was  used,  but  subsequently  it 
was  increased  to  four,  five,  ten,  and  twenty  per  cent.  Merck 
has,  however,  introduced  a  preparation  known  as  the  Cit- 
rate of  Cocaine,  in  the  form  of  pills,  made  by  incorporating 
it  with  gum  tragacanth  dissolved  in  glycerine,  each  pill  con- 
taining yi  grain  of  the  citrate,  in  which  form  it  retains  its 
strength.  The  citrate  of  cocaine,  however,  in  solution,  will 
decompose  in  three  or  four  days. 

Dr.  John  S.  Marshall,  from  experiments  made  with  the 
citrate  of  cocaine,  is  of  the  opinion  that  it  is  more  reliable 
when  applied  to  hypersensitive  dentine  or  to  the  dental  pulp, 
than  the  first  two  forms,  but  appears  to  possess  no  special 
advantages  over  them  for  operations  on  submucous  tissues  or 
in  the  extraction  of  teeth. 

Another  salt  of  cocaine,  the  hydrobromate ,  has  been  pro- 
duced by  Dr.  Lyons  by  a  combination  of  hydrobromic 
acid,  with  cocaine,  in  the  form  of  slender,  translucent  prisms, 
of  snowy  whiteness.  It  is  claimed  that  the  local  anaesthetic 
effect  of  this  preparation  is  greater,  for  the  same  amount  ot 
solution,  than  that  of  any  of  the  other  salts  employed. 

Medical  Properties  and  Action. — Dr.  Niemann,  of  Goslar,  as 
early  as  i860,  noted  the  fact  that  cocaine,  when  applied  to  the 
tongue,  produced  local  anaesthesia  but  his  investigations,  as 
well  as  those  of  others  at  a  later  period,  appear  to  have  been  for- 
gotten, until  1884,  when  Dr.  Koller,  of  Vienna,  demonstrated 
the  action  of  cocaine,  in  solution,  on  the  eye.  Apparently 
very  little  is  known  concerning  the  physiological  action  of 
cocaine,  but  that  it  is  a  valuable  local  anaesthetic  and  local 
anodyne  is  beyond  question.  It  appears  to  paralyze  the  nerves 
of  the  vessels,  causing,  at  the  same  time,  a  constriction,  as  is 
evident  from  the  blanching  of  the  part  acted  on.  Many  are 
of  the  opinion  that  its  effects  are  mainly  due  to  its  influence 
upon  the  sympathetic.  When  one  drop  of  a  2  or  4  per  cent. 
21 


322  DENTAL   MEDICINE. 


solution  of  cocaine  is  applied  to  the  eye,  a  slight  burning 
sensation  is  felt,  and  a  minute  or  two  later  the  cornea  and  con- 
junctiva become  anaesthetized,  and  lose  all  reflex  excitability. 
The  finger  can  be  passed  over  the  cornea  and  conjunctiva,  and 
the  latter  can  be  taken  up  with  the  forceps,  without  pain.  At 
the  same  time  there  is  a  feeling  of  tension  in  the  lids,  and  the 
eyes  seem  protruding.  These  effects  last  about  ten  minutes 
and  gradually  disappear.  Dr.  Konigstein  reports  having  re- 
moved the  eyeball  of  a  dog  cocainized,  without  the  animal 
feeling  any  pain.  A  ten  or  twenty  per  cent,  solution  is  used, 
according  to  the  sensitiveness  of  the  parts  and  the  nature  of 
the  operation,  when  less  sensitive  organs  than  the  eye  have 
to  be  obtunded.  For  the  larynx,  it  should  be  applied  three  or 
four  times,  at  intervals  of  ninety  seconds;  for  the  eye,  a  drop 
of  the  two  per  cent,  solution,  at  intervals  of  two  minutes,  the 
maximum  effect  being  reached  in  fifteen  minutes.  Dr.  Jelinek 
recommends  a  dilute  alcoholic  solution  of  ten  or  twenty  per 
cent.  For  the  former  strength  the  proportion  of  alcohol  to 
water  should  be  one  to  four ;  for  the  latter,  two  to  three. 

Therapeutic  Uses. — Cocaine  is  employed  in  some  forms  of 
insanity,  melancholia*  neurasthenia,  gastralgia  and  in  wasting 
diseases,  pruritic  skin  affections  and  hoarseness.  The  leaves 
in  cigarettes  have  relieved  hay  fever  and  throat  affections.  Co- 
caine is  employed  as  a  local  anaesthetic  and  local  anodyne  in 
all  painful  affections  of  the  eye,  the  operation  for  cataract,  al- 
though the  evidence  as  to  its  reliability  in  such  deep  opera- 
tions as  iridectomy,  cataract,  squint,  etc.,  is  conflicting.  (There 
are,  however,  cases  reported  by  Dr.  Konigstein  of  even  the 
surfaces  of  the  eyelids  entirely  losing  their  sensitiveness  when 
hydrochlorate  of  cocaine  was  applied  in  solid  form.)  It  is  also 
employed  in  painful  affections  of  the  pharynx  and  larynx,  or 
of  any  other  excitable  mucous  membrane  or  of  nerve  tissue. 
Prof.  Engle  reports  a  case  of  tregeminal  neuralgia  successfully 
treated  by  hypodermic  injections  of  the  hydrochlorate  of  co- 
caine. Dr.  Wagner  of  Vienna,  basing  a  theory  upon  the  es- 
tablished principle  that  fluids  move  from  the  positive  to  the 
negative  pole  in  a  galvanic  current,  saturated  the  positive  elec- 


COCAINE.  323 

trode  with  a  strong  cocaine  solution,  applied  it  to  the  skin  and 
applied  the  negative  pole  a  short  distance  from  the  positive,  and 
found  that  incisions  could  be  made  without  producing  any  pain. 

Dr.  Lewis  H.  Adler,  Jr.,  writing  on  the  status  of  hydrochlor- 
ate  of  cocaine  in  minor  surgery,  says  : 

"  hi  minor  surgery,  cocaine,  when  used  hypodermically,  is 
of  value  in  all  operations  in  which  the  circulation  can  be  tem- 
porarily arrested,  in  order  to  prevent  undue  absorption  of  the 
drug,  and  in  which  free  bleeding  can  be  encouraged  at  the 
completion  of  the  operation  previous  to  the  tying  of  the  sutures, 
to  allow  as  much  of  the  unabsorbed  cocaine  to  be  washed  out 
as  is  possible.  Attention  paid  to  these  two  essential  points 
will,  as  a  rule,  obviate  any  untoward  results  from  the  use  of 
cocaine  employed  hypodermically  for  anaesthetic  purposes.  It 
is  likewise  important  to  make  use  of  freshly  prepared  solutions, 
as  otherwise  the  formation  of  fungi  is  liable  to  occur  and  the 
preparation  to  be  spoiled.  To  prevent  this  alteration,  antisep- 
tic agents  are  added,  the  best  one  being  boracic  acid,  as  it  is 
the  least  irritating.  Such  a  solution  usually  consists  of  about 
twenty  grains  of  cocaine  and  ten  grains  of  boracic  acid,  dis- 
solved in  an  ounce  of  distilled  water.  A  preparation  of  this 
character  has  been  used  by  the  writer  with  perfectly  satisfactory 
results,  even  when  it  has  been  over  two  months  old. 

Another  point  of  considerable  importance  in  using  cocaine 
hypodermically  is  to  make  use  of  a  perfectly  aseptic  syringe ; 
frequently  in  cases  where  the  drug  is  so  used  and  suppuration 
follows,  it  is  the  fault  of  want  of  cleanliness  in  this  particular, 
and  not  to  the  employment  of  the  drug. 

A  four  per  cent,  solution  is  as  strong  as  need  be  used  for 
hypodermic  injections.  The  principal  advantages  in  using  a 
solution  of  no  greater  strength  are,  that  the  anaesthetic  prop- 
erty of  cocaine  can  be  made  to  reach  to  a  larger  area  with  a 
less  amount  of  the  drug  than  is  the  case  when  a  more  concen- 
trated one  is  employed ;  and,  furthermore,  the  dilution  of  the 
drug  renders  it  less  liable  to  produce  toxic  symptoms. 

When  the  circulation  cannot  be  controlled,  extreme  caution 


324  DENTAL  MEDICINE. 


must  be  observed  in  the  use  of  the  drug ;  especially  is  this  the 
case  when  any  considerable  quantity  is  required. 

The  quantity  of  cocaine  required  to  produce  anaesthesia 
varies  with  the  operation  and  its  extent ;  as  a  rule  for  ordinary 
minor  operations  from  25  to  40  minims  of  a  four  per  cent, 
solution  are  needed.  The  length  of  time  necessary  for  the 
production  of  local  anaesthesia  or  insensibility  under  cocaine 
varies  from  three  to  ten  minutes. 

Individual  susceptibility  to  the  toxic  influence  of  cocaine  is 
a  complication  of  sufficiently  frequent  occurrence  to  surround 
the  use  of  the  drug  with  due  care  and  caution ;  but  it  is  not  a 
contraindication  to  the  employment  of  the  agent  as  an  anaes- 
thetic. Untoward  effects  may  arise  from  the  use  of  any 
one  of  the  anaesthetic  substances. 

Another  objection  urged  by  some  surgeons  to  the  employ- 
ment of  cocaine  for  anaesthetic  purposes  is  based  on  its  asserted 
power  of  inducing  the  so-called  "cocaine  habit."  As  yet,  this 
influence  of  the  drug  is  extremely  rare.  It  is  most  liable  to 
occur  among  the  patients  who  are  informed  of  the  nature  of 
the  remedy  used,  and  especially  is  this  the  case  when  it  is  em- 
ployed internally  for  medicinal  purposes.  I  hardly  believe 
that  this  action  of  cocaine  can  be  produced  when  it  is  employed 
for  its  local  anaesthetic  effect  and  in  the  small  quantity  needed 
to  induce  local  insensibility."  Dr.  Edward  T.  Reichert,  from 
a  careful  study  of  the  actions  of  cocaine  on  the  circulation  in 
animals,  deduced  the  following  conclusions  :  i.  The  discrep- 
ancies in  the  testimony  offered  by  different  experimenters,  in 
their  investigations  of  the  action  of  cocaine  on  the  circulation, 
are  almost  wholly  due  to  variations  in  the  absolute  doses  em- 
ployed, and  to  the  individual  susceptibility  of  the  animals. 
2.  The  minimal  fatal  dose,  when  injected  intravenously  in 
divided  doses  in  the  form  of  a  one  per  cent,  solution,  varies 
from  0.004  to  0.03  gramme  to  the  kilo  of  the  body  weight. 
Owing  to  the  great  differences  in  the  sensitiveness  of  different 
dogs  to  the  poison,  a  moderate  dose  in  one  animal  might 
prove  a  small  or  a  large  one  in  another  of  similar  weight.  3. 
When  the  full  train  of  effects  on  the  heart-beat  is  slowly  de- 


COCAINE.  ■  325 


veloped  by  the  repeated  injection  of  very  small  doses  (o.ooi 
gramme  to  the  kilo  of  body  weight),  the  pulse  rate  is  at  first 
decreased,  then  increased,  and  finally  decreased.  A  single  very 
small  dose  causes  a  decrease,  a  small  to  a  moderate  dose  an 
increase ;  large  doses  a  transient  decrease  followed  by  an  in- 
crease ;  very  large  doses  a  more  or  less  permanent  decrease. 
The  primary  decrease,  which  only  can  be  developed  by  very 
small  doses,  is  due  to  a  stimulation  of  the  cardio-inhibitory 
centres  ;  the  secondary  increase  to  a  depression  of  the  same 
centres,  and  which  may  be  assisted  by  a  similar  action  on  the 
cardio-inhibitory  peripheries ;  and  the  final  decrease  to  a  de- 
pression either  of  the  accelerator  or  automatic  motor-ganglion 
in  the  heart.  The  height  of  the  pulse  curves  during  these 
changes  is  always  in  adverse  relation  to  the  frequency  of  the 
beat.  4.  The  cardio-inhibitory  centres  are  invariably  affected, 
being  primarily  stimulated,  and  secondarily  depressed  ;  but  the 
action  on  the  peripheries  is  of  a  very  inconsistent  character : 
although  a  primary  stimulant  action  is  never  manifest,  the 
depressant  action  is  sometimes  present  to  a  profound  degree 
very  early  in  the  poisoning,  and,  at  others,  absolutely  absent 
up  to  the  time  of  death.  5.  The  arterial  pressure  is  always 
increased,  unless  it  be  after  large  doses,  when  it  may  tempor- 
arily be  diminished,  followed  by  a  rise  above  the  normal;  or 
after  very  large  doses,  be  permanently  lowered.  The  increase 
may  be  decided  long  after  the  development  of  the  third  stage 
of  the  actions  of  the  heart,  and,  therefore,  may  outlast  the 
period  of  the  acceleration  of  the  heart's  beat.  The  increase  is 
chiefly  due  to  a  stimulation  of  the  vaso-motor  centres  in  the 
medulla  oblongata :  to  a  slight  stimulation  direct  of  the  vessel- 
walls  ;  and  to  the  acceleration  of  the  pulse.  The  final  fall  of 
pressure  is  chiefly  dependent  upon  a  depression  of  the  heart, 
and  partly  to  vaso-motor  depression.  6.  The  effects  of  cocaine 
in  normal  and  curarized  animals  are  identical,  unless,  in  the 
latter,  the  curare  has  been  used  to  excess.  7.  Cocaine  is  a 
decided  circulatory  stimulant. 

Dental    Uses. — In   operations   in   the   mouth,   affecting    the 
mucous   membrane  and  the    immediately   subjacent   tissues, 


326  DENTAL  MEDICINE. 


the  salts  of  cocaine  have  proved  efficient  for  their  local  anaes- 
thetic and  anodyne  effects.  But  for  operations  on  deep-seated 
tissues,  such  as  are  involved  in  the  extraction  of  teeth,  the 
action  of  cocaine  has  been,  as  Dr.  W.  W.  Allport  remarked,  "so 
uncertain  as  to  render  its  practicable  benefits  questionable." 
Cocaine  has,  however,  proven  very  efficient  in  relieving  the 
pain  of  the  surgical  treatment  of  alveolar  pyorrhoea,  the  extir- 
pation of  the  pulps  of  teeth,  and,  in  some  cases,  that  of  hyper- 
sensitive dentine.  Exposed  pulps  are  rendered  less  painful  after 
being  treated  with  a  five  per  cent,  solution  of  cocaine,  to  which, 
in  some  cases,  morphine  has  been  added.  In  some  cases  also, 
it  is  claimed,  highly  inflamed  pulps  have  been  successfully 
capped,  as  an  experiment,  with  a  paste  of  cocaine  and  glycerine, 
although,  as  was  foreseen,  the  anaesthetic  did  not  arrest  the 
course  of  the  pulpitis.  In  treating  hypersensitive  dentine,  the 
more  sensitive  the  structure  the  stronger  the  solution  of  cocaine 
to  be  employed.  The  pure  cocaine  in  the  form  of  crystals,  of 
the  hydrochlorate  or  other  salts,  in  the  form  of  powder,  have 
proven  efficient  when  applied  to  hypersensitive  dentine  ;  while 
the  twenty  per  cent,  solution  of  the  salts  has  relieved  the 
acute  pain  which  is  common  to  such  a  condition.  It  is  also 
claimed  that  the  crystals  of  cocaine,  applied  to  the  gum,  close 
to  a  tooth  to  be  extracted,  three  times,  at  intervals  of  two 
minutes  each,  has  secured  a  painless  operation.  It  has  been 
suggested  that  immediately  after  the  application  of  the  cocaine 
crystals  to  the  gum,  three  or  four  minims  of  a  four,  per  cent, 
solution  be  injected  with  a  hypodermic  syringe,  between  the 
gum  and  the  neck  of  the  tooth  to  be  extracted.  For  the 
extirpation  of  pulps  of  teeth,  it  is  recommended  first  to  anaes- 
thetize the  pulps  superficially,  with  a  paste  of  cocaine  and 
glycerine,  and  then  to  introduce,  by  means  of  a  syringe,  a 
twenty  per  cent,  solution  of  cocaine  directly  on  the  exposed 
portion  of  the  pulp,  when  it  can  be  removed  with  a  nerve 
extractor  without  causing  any  pain.  Dr.  John  S.  Marshall, 
from  his  experiments  with  the  pills  of  citrate  of  cocaine,  found 
that  under  favorable  circumstances,  the  citrate,  in  such  a  form, 
produces  anaesthesia,  when  applied  to  sensitive  dentine,    in 


COCAINE.  327 

from  five  to  ten  minutes,  and  that  the  obtunding  effect  is  of  a 
duration  sufficient  for  the  preparation  of  the  cavity.  He  was 
also  able  to  extirpate  the  pulp  of  the  tooth,  after  the  citrate 
had  been  applied,  in  from  three  to  twelve  minutes.  In  using 
the  citrate  in  the  form  of  pills,  one  pill  is  introduced  into  the 
sensitive  cavity,  and,  after  being  secured  with  a  pledget  of 
cotton,  moistened  in  tepid  water,  is  permitted  to  remain  from 
five  to  twelve  minutes.  Dr.  Marshall  suggests  the  use  of 
granules,  containing  one-sixteenth  of  a  grain  of  pure  citrate 
of  cocaine,  instead  of  pills  containing  glycerine  and  saccharine 
matters.  A  solution  of  the  salts  of  cocaine  has  also  been 
subcutaneously  injected,  with  favorable  results,  for  the  relief 
of  the  pain  resulting  from  periodontitis  and  dental  exostosis  ; 
and  Dr.  Hillischer  recommends  the  rubbing  in  of  cocaine, 
either  in  substance  or  in  concentrated  solution,  after  the  epi- 
thelium has  been  macerated  with  tincture  of  iodine,  to  pro- 
mote absorption,  to  relieve  the  pain  of  chronic  periodontitis ; 
also  the  repeated  application  of  the  concentrated  solution  to 
relieve  the  ulcers  of  thrush,  aphthae,  etc.  In  the  surgical 
treatment  of  alveolar  pyorrhoea,  the  pain  may  be  relieved  by 
first  applying  dilute  alcohol  to  the  gums,  by  means  of  a 
camel's  hair  brush,  and  then  in  the  same  manner,  a  ten  per 
cent,  solution  of  cocaine,  repeating  the  application  of  the 
cocaine  once  or  twice  during  the  space  of  five  minutes.  The 
slowness  of  the  action  of  cocaine  is  a  great  objection  to  its 
use  as  an  anaesthetic. 

The  four  per  cent,  or  five  per  cent,  solution  applied  to  a 
tooth  unprotected  by  a  rubber  dam  (as  the  rubber  prevents 
the  anaesthetic  action  of  the  agent),  for  the  space  of  twenty 
minutes,  repeating  the  application  if  necessary,  is  recom- 
mended by  Dr.  Thompson.  Dr.  A.  W.  Harlan  recommends 
a  solution  composed  of  cocaine  hydrochlorate,  ten  grains,  in 
sulphuric  ether,  ninety  minims,  which  is  to  be  applied  for  four 
or  five  minutes,  for  the  painless  extirpation  of  an  exposed 
pulp. 

Dr.  Harper  recommends  the  following  method  for  removing 
pulps  of  teeth  by  the  use  of  crystals  of  cocaine :  "  Take  a  drop 


328  DENTAL  MEDICINE. 


of  the  oil  of  cloves  and  add  enough  cocaine  to  make  a  thick 
paste  and  introduce  it  into  the  pulp,  after  having  first  put  the 
rubber  dam  on  the  tooth ;  then  with  a  broach  slowly  work  it 
down ;  with  a  bur  open  up  the  opening  slowly,  and  in  ten  or 
fifteen  minutes  the  pulp  may  be  removed  from  any  of  the 
anterior  teeth."  Where  arsenic  has  been  applied  to  the  pulp 
and  the  patient  returns  with  pain,  he  finds  that  he  can  get 
better  satisfaction  from  the  application  of  cocaine. 

Herbsfs  Obtundent  con'SAs\.s  of  a  saturated  solution  of  cocaine 
hydrochlorate  in  chemically  pure  sulphuric  acid,  to  which  sul- 
phuric ether  is  added  to  the  point  of  saturation,  the  excess  of 
the  ether  floating  upon  the  surface  and  evaporating.  Several 
applications  are  necessary  to  produce  anaesthetic  effects,  and 
seventy  grains  of  cocaine  hydrochlorate  are  required  to  satu- 
rate two  drachms  of  the  sulphuric  acid. 

Cocaine,  owing  to  the  unsatisfactory  results  which  have 
attended  its  use  as  a  local  application,  is  now  generally  applied 
by  hypodermic  injection,  for  the  extraction  of  teeth.  Owing 
to  the  necessity  for  introducing  the  agent  deeply  into  the  tis- 
sues, Dr.  Walb's  method  is  to  inject  a  two  per  cent,  solution 
of  the  hydrochlorate  of  cocaine  hypodermically  over  the  root 
of  the  tooth  to  be  extracted,  the  injections  being  usually  made 
on  each  side  of  the  gum,  above  the  root  of  the  tooth,  and  as 
many  as  the  number  of  teeth  to  be  extracted  may  indicate ; 
the  same  method  is  employed  for  obtunding  hypersensitive 
dentine,  and  in  removing  pulps.  The  full  anaesthetic  effect  is 
developed  in  from  five  to  ten  minutes,  and  continues  ten  or 
fifteen  minutes.  It  has  also  been  suggested  to  hypodermically 
inject  the  solutions  of  cocaine  upon  both  the  lingual  branch 
and  the  inferior  dental  branch  of  the  inferior  maxillary  nerve, 
the  former  being  preferred  by  some,  on  account  of  its  sup- 
plying the  alveoli  and  gums ;  but  greater  success  appears  to 
result  from  injecting  the  gum  on  each  side  of  the  tooth.  Dr. 
Raymond  recommends  charging  the  syringe  with  .^  thirteen 
minims  of  a  four  per  cent,  solution  of  cocaine,  and  to  direct 
the  needle-point  on  a  line  extending  about  midway  between 
the  angle  and  the  coronoid  process  of  the  inferior  maxillary. 


COCAINE.  329 

passing  through  the  internal  pterygoid  muscle,  and,  using  the 
finger  on  the  internal  oblique  line  as  a  guide,  to  carry  the 
needle-point  along  inner  surface  of  ramus  until  the  nerve  is 
reached,  where  it  enters  the  inferior  dental  foramen,  for  opera- 
tions on  the  inferior  molar  teeth. 

Dr.  Raymond  also  suggests  the  following  method  of  pre- 
paring and  applying  cocaine:  Obtain  a  quantity  of  the  soluble 
alkaloid,  and  mix  it  at  the  time  of  using  it  (as  it  deteriorates 
when  long  kept).  The  requisites  are  a  minim  glass,  pair  of 
scales,  some  filtering  paper,  and  a  little  water  that  has  been 
boiled.  It  is  necessary  to  have  an  easy-working  syringe,  with 
a  perfectly  smooth,  sharp  needle.  Care  must  be  taken  to 
exhaust  the  air  from  the  syringe  when  charged  ready  for  use. 
This  can  be  done  by  drawing  in  more  of  the  solution  than  is 
needed,  and  pressing  it  out  to  the  required  number  of  minims. 
Hold  the  needle-point  up,  so  as  to  allow  the  air  to  get  above 
the  solution,  then  press  the  piston. 

The  needle  of  the  hypodermic  syringe  should  be  fine,  sharp 
and  clean,  and  rendered  thoroughly  aseptic  previous  to  its 
employment,  which  may  be  accomplished  by  drawing  up 
through  it  a  few  drops  of  any  good  antiseptic  solution,  such 
as  strong  carbolic  acid,  and  the  solution  should  be  freshly 
prepared  for  each  operation  as  the  salts  of  cocaine  rapidly 
decompose ;  or  the  needle  of  the  syringe  can  be  immersed 
in,  and  the  barrel  filled  with,  boiling  water  rendered  alkaline 
by  the  addition  of  a  small  quantity  of  bicarbonate  of  soda. 
The  salt  should  be  dissolved  in  slightly  warm  water,  and 
the  strength  of  the  solution  vary  from  5  to  20  per  cent.  A 
five  per  cent,  solution  is  made  by  dissolving  y^  grain  of  cocaine 
in  10  minims  of  water.  Previous  to  the  injection,  the  gum 
should  be  dried  about  the  tooth,  and  a  folded  napkin  so  placed 
as  to  exclude  the  saliva.  All  air  must  be  expelled  from  the 
syringe,  and  the  gum  at  the  point  the  needle  of  syringe  is  to 
enter,  should  be  obtunded  by  applying  a  few  drops  of  the 
solution  to  the  mucous  membrane,  so  as  to  render  the  punc- 
ture painless.  It  is  recommended  to  inject  the  solution  at 
three  points,  two  punctures  on  the  labial  or  buccal  surface, 


330  DENTAL   MEDICINE. 


and  one  on  the  palatine  or  lingual  surface.  The  point  of  the 
needle  should  be  inserted  about  one-sixth  of  an  inch  below 
the  free  margin  of  the  gum,  and  pressed  in  obliquely,  upwards 
or  downwards,  as  the  case  may  be,  in  a  direction  towards  the 
apex  of  the  tooth,  until  the  point  of  the  needle  rests  against 
the  bone;  all  of  the  soft  tissues  must  be  penetrated.  With  the 
needle  in  position,  and  a  finger  placed  on  either  side  and 
pressed  with  some  force  against  the  gum  to  keep  the  tissues 
in  place,  the  solution  should  be  slowly  injected,  when  the  gum 
should  appear  completely  blanched  in  the  neighborhood  of 
the  puncture.  After  injecting  the  solution,  the  needle  should 
not  be  withdrawn  for  several  seconds,  and  then  a  finger  should 
be  placed  over  the  puncture  to  prevent  any  escape  of  the 
solution.  Some  six  or  seven  minutes  elapse  before  the  full 
anaesthetic  effects  of  the  cocaine  are  obtained.  Dr.  Gask 
recommends  placing  a  few  crystals  of  the  salt  just  around  the 
neck  of  the  tooth  to  render  painless  the  application  of  the 
forceps,  and  he  prefers  for  injection  hydrochlorate  of  cocaine 
in  the  form  of  half-grain  tabloids.  Rinsing  the  mouth  with 
hot  water  before  the  injection  of  cocaine  solution,  and  again 
afterwards,  and  repeating  the  injection,  is  a  method  which  is 
attended  with  satisfactory  results. 

The  combined  use  of  cocaine  and  chloroform  is  advocated 
by  Obolinski,  who  injects,  either  before  or  after  the  anaesthesia 
is  obtained,  from  one  to  three  centigrammes  of  cocaine ;  or  he 
injects  in  the  neighborhood  of  the  seat  of  operation,  and  dur- 
ing its  progress,  from  three  to  seven  centigrammes.  Cocaine 
is  thus  used  on  the  ground  that  it  is  a  complete  antagonist 
to  chloroform,  of  which,  however,  there  is  some  doubt,  as 
cocaine  is  rather  a  general  excitant  of  the  central  nervous 
gray  matter  than  a  direct  and  powerful  stimulator  of  the 
heart,  while  its  stimulant  effect  upon  respiration  is  not  to  be 
depended  upon.  Obolinski  claims  that  this  mixed  narcosis 
requires  the  use  of  less  chloroform,  that  vomiting  is  pre- 
vented, and  that  there  are  few  disagreeable  after-effects.  Dr. 
Gordon  White  recommends  a  saturated  solution  of  cocaine 
hydrochlorate  in  ether  as  an  excellent  preparation  for  sensi- 
tive dentine  and  pulp-extirpation. 


COCAINE.  331 

Krogius  describes  a  method  of  producing  cocaine  anal- 
gesia, which  is  based  on  the  fact  that  when  a  solution  of 
this  agent  is  injected  into  the  subcutaneous  tissue  near  to  a 
nerve-trunk  it  causes  loss  of  sensation  over  a  large  zone  cor- 
responding to  the  peripheral  distribution  of  this  nerve.  In 
order  to  reach  the  selected  nerve-trunk  with  certainty,  and  to 
apply  the  cocaine  to  several  of  its  branches  at  the  same  time, 
the  author,  in  injecting  the  subcutaneous  tissue,  passes  his 
needle  across  the  long  axis  of  the  limb,  and  as  the  needle  is 
thrust  along  the  solution  is  gradually  discharged.  An  injec- 
tion made  in  this  way  across  the  root  of  a  finger  will,  in  the 
course  often  minutes,  result  in  analgesia  of  the  whole  digit, — 
not  of  the  skin  only,  but  also  of  the  tendons,  the  periosteum, 
and  all  the  deep  structures.  If  one  or  two  injections  be  made 
transversely  near  the  wrist,  a  considerable  extent  of  the  palm 
of  the  hand  may  be  thus  rendered  analgesic.  The  sensibility 
of  the  ulnar  side  of  the  hand  as  far  as  the  roots  of  the  last  two 
fingers  may,  it  is  stated,  be  abolished  by  injecting  a  solution 
of  cocaine  over  the  ulnar  nerve  at  the  back  of  the  elbow.  By 
injecting  over  both  supraorbital  notches,  analgesia  may  be 
produced  in  the  whole  of  the  middle  portion  of  the  forehead. 
The  analgesia  caused  by  this  method  of  using  cocaine  attains 
its  greatest  intensity  and  extent  from  five  to  ten  minutes  after 
the  injection,  and  is  maintained  for  a  quarter  of  an  hour  or 
even  longer.  The  author  injects  only  a  weak  (two-per-cent.) 
solution  of  cocaine,  and  keeps  the  patient  recumbent  for  at 
least  a  quarter  of  an  hour  after  the  operation.  This  method 
has  been  practiced  with  success  at  Helsingfors  in  two  hundred 
minor  operations,  such  as  amputation  of  the  fingers  and  toes, 
excision  of  palmar  fascia  and  phimosis. 

Dr.  A.  C.  Gask  recommends  painting  the  palate  with  a  five 
per  cent,  solution  of  cocaine  for  obtaining  impressions  of 
mouths  which  exhibit  great  intolerance  to  the  introduction  of 
all  impression  materials  ;  also  a  20  per  cent,  solution  applied 
to  the  mucous  membrane  on  cotton,  for  service  in  wedging 
and  separating  teeth,  in  forcing  silk,  etc.,  up  in  high  conical 
edges,  in  removing  portions  of  overhanging  gum,  in  lancing 


332  DENTAL  MEDICINE. 


abscesses,  in  treating  alveolar  pyorrhoea,  in  extirpation  of 
pulps,  and  in  the  treatment  of  teeth  very  sensitive  from  perio- 
dontitis ;  also  in  the  form  of  a  ^  grain  compressed  tabloid 
placed  in  the  cavity,  to  relieve  the  pain  following  extraction. 

Dangers  of  Cocaine. — The  dangers  from  the  use  of  cocaine 
are  enumerated  as  follows :  Certain  persons  possess  an  idio- 
syncrasy to  cocaine,  which  cannot  be  foreseen  or  entirely 
guarded  against ;  it  exerts  its  toxic  effects  upon  the  nervous 
centres  and,  secondarily,  the  heart ;  its  evil  effects  are  most 
liable  in  neurotic  subjects ;  the  danger  in  cocaine  poisoning  is 
mainly  from  paralysis  of  the  heart,  syncope ;  special  care  is 
necessary  in  "  weak  heart "  and  organic  heart  disease ;  many 
regard  its  subcutaneous  administration  as  dangerous,  and 
that  it  should  be  avoided ;  the  use  of  the  strongest  solutions 
is  dangerous  and  unnecessary ;  that  it  may  be  well  to  precede 
its  use  by  the  administration  of  alcohol  or  other  cardiac 
stimulant,  as  is  done  with  chloroform. 

Patients  of  a  sanguine  temperament  and  in  good  health  are 
the  most  favorable  subjects  in  the  use  of  cocaine  ;  while  the 
nervous,  hysterical,  and  those  exhibiting  great  dread  of  the 
impending  operation,  as  well  as  pregnant  women,  may  be  re- 
garded as  unfavorable  subjects.  Great  care  should  also  be 
taken  to  prevent  even  the  weakest  solution  of  cocaine  from 
running  down  into  the  fauces,  and  restorative  agents  should 
always  be  at  hand. 

Cocaine  appears  to  be  absorbed  with  extraordinary  rapidity, 
and  the  stronger  the  solution  which  is  locally  applied,  the 
greater  the  danger  of  toxic  symptoms.  The  rapidity  of  the 
absorption  varies  in  the  different  tissues,  absorption  occurring 
most  rapidly  through  the  conjunctiva,  then  through  the  nose, 
larynx,  mouth,  and  ear.  A  ten  per  cent,  solution  is  sufficiently 
strong  for  most  purposes,  and  is  less  dangerous  than  one  of 
greater  strength. 

Treatment  of  Cocaine  Poisoning. — The  treatment  of  cocaine 
poisoning  consists  of  measures  to  rouse  the  heart,  especially 
inhalations  of  the  nitrite  of  amyl,  and  such  restoratives  as 
brandy,   whiskey,  aromatic   spirits    of  ammonia,    strychnine. 


COCAINE.  333 

atropine,  digitalis,  ether  and  chloroform  (when  convulsions 
are  present),  or  five  minims  of  carbonate  of  ammonia  by  injec- 
tion, also  nitrite  of  amyl  by  inhalation.  The  hot-baths,  hot 
drinks,  and  hot  sinapisms  over  the  heart,  and  friction  are 
often  serviceable ;  also  artificial  respiration.  M.  Elroy  re- 
commends flagellation  with  wet  towels,  massage,  and  arti- 
ficial respiration,  if  asphyxia  threatens  ;  inhalations  of  chloro- 
form against  tetanization  of  the  respiratory  muscles ;  where 
there  is  great  pallor  to  provoke  vaso-dilatation,  and  to  dimin- 
ish the  encumberment  of  the  central  circulation  by  the  in- 
halation of  amyl  nitrite.  If  these  means  prove  ineffectual  and 
deglutition  is  impossible,  give  hypodermic  injections  of  caffein 
and  of  sulphuric  ether  (15,  30,  even  45  minims).  M.  Chouppe 
recommends  in  addition  the  hypodermic  injections  of  mor- 
phine, but  only  in  the  very  outset,  and  as  large  as  from  one- 
half  to  five-eighths  of  a  grain. 

Efforts  should  be  made  to  moderate  the  reflex  excitability 
of  the  nervous  system,  sustain  the  heart,  and  re-establish  the 
equilibrium  of  the  blood-pressure. 

Cocaine  is  also  employed  in  combination  with  arsenious 
acid  for  a  devitalizing  mixture.  (See  Arseniotis  Acid).  One 
grain  of  cocaine  to  one-eighth  ounce  of  chloroform  is  em- 
ployed for  extirpating  pulps  without  pain. 

Cocaine  Inconipatibles. — When  combined  with  nitrate  of  sil- 
ver, decomposition  of  the  hydrochloride  occurs  with  the  for- 
mation of  an  insoluble  chloride  of  silver,  and  a  corresponding 
change  in  the  cocaine.  If  calomel  and  hydrochlorate  of  Co- 
caine are  rubbed  tog^ether,  chemical  reaction  begins.  Added 
(  ^  .    .      .  . 

to  mercuric  oxide,  an  irritating  instead  of  an  anaesthetic  action 

is  produced,  due  to  the  formation  of  oxychloride  of  mercury. 
Test  for  Presence  of  Cocaine. — H.  Garlton  Smith  gives  the 
following  simple  test :  "  To  a  solution  of  cocaine  was  added  a 
few  drops  of  ferric  chloride  ;  the  iron  was  reduced  as  usual ; 
then  the  addition  of  a  single  drop  of  stannous  chloride  pro- 
duced a  white  precipitate.  This  disappeared  upon  shaking, 
but  one  or  two  more  drops  of  the  chloride  of  tin  reproduced 
it,  and  this  time  it  was  permanent." 


334 


DENTAL  MEDICINE. 


DENTAL 

To  Make  a  Solution  of  Hydrochlorate 
of  Cocaine  (4  per  cent.). 

R.    Cocaini  hydrochloratis 

(cryst.) gr.18.228 

Aquse  destillatat   .    .    .  fgj.        M. 

Fo7'  Exposed  Pulps. 

R .    Cocaini  hydrochloratis 

(cryst.) gr.vj 

Spiritus  menthse  pip.    .  f^j.       M. 
SiGNA. — Apply  on  a  pledget  of  cotton. 

For  Local  Ancesthesia. 

H.  J.  McKellops. 

R.    Mur.  cocaini    ....  gr.iss 
Spts.   alcoholis     .    .    .  ^j 
Chloroformi |j.         M. 

For  Neuralgia  and  Odontalgia. 

R .    Cocaini  hydrochloratis 

(cryst.) gr.vj 

Menthol gr.xxx 

Alcoholis  q.  s.  ad    .    .  f^j.        M. 
SiGNA. — Apply    as    a    lotion,  or  on    a 
pledget  of  cotton. 

Chloroform  or  bromide  of  ethyl  may 
be  substituted  for  the  alcohol. 

To  Make   Oleale  of  Cocaine. 
(Five  per  cent.) 

R .    Cocaine  (alkaloid)  .    .    gr.  2^ 
Acidi  oleic  (pure)    .    .  TTl^^ 
Olei  amygdalae    .    .    .  HfLxl. 
Dissolve  the   alkaloid    in   the   oleic 

acid  and  add  the  almond  oil. 

For  Pain  of  Difficult  Dentition. 

M.    VlQUIER. 

R .    Cocaine  hydrochloratis  gr.ij 

Syrup  simp ^ijss 

Tinct.  saffron    ....   gtt.x.     M. 

SiGNA. — Rub    the    painful    gums    fre- 
quently during  the  day. 


FORMULA. 

For  Local  Ancesthesia. 
J.  M.  Lewis. 

R.    Cocaini  hydrochloratis  grs.viii 
Chloralis  hydrat   .    .    .  gr.v 
Acidi  carbolic!    .    .    .  gtt.iij 
Aquse  destil ^3"]-     '^■ 

SiGNA. — Inject  2  or  3  drops    into  the 
gum  at  one  time. 

For  Hypersensitive  Dentine. 
R .  Cocaini   hydrochloratis 

(cryst.) gr.x 

Tragacanth.  glyceritum  q.s. 
Form  a  mass. 
SiGNA. — Insert    a    minute    portion    in 
cavity  half  an  hour  before  operating. 

For  Neuralgia  and  Odontalgia. 
R .    Cocaini  hydrochloratis 

(cryst.)      .....  gr.xv 
Olei  caryophylli  .    .    .  f^j.       M. 
SiGNA. — Apply  as   a   lotion,  or   on   a 
pledget  of  cotton. 

Local  AncEsthetic. 
R .    Cocaine  hydrate  (4  per 

cent,  solution)  .    .    .  ^iij 
Carbolic  acid    ....  gtt.v 
Chloral  hydrate    .    .    .  gr.v.      M. 
SiGNA. — Use    hypodermically    around 
tooth  with  care. 

Local  Ancesthetic  for  Extraction  of 
Teeth. 

Dr.  J.  W.  Hope. 

R .    Cocaini      hydrochlo- 
ratis          5  parts 

Acidi  carbolici  .  .  6  parts 
Camphorse  (pine  gum)  6  parts 
Alcoholis     (95      per 

cent.)  q.  s.  to  make  120  parts  M. 
SiGNA. — Inject  with  a  hypodermic  syr- 
inge I  to  3  minims  deeply  into  inner 
and  outer  surfaces  of  gum.     Apply 


COCAINE. 


335 


over  the  gum  absorbent  cotton  satu- 
rated with  the  solution.  Wait  4  or 
5  minutes. 

Local  AncEstketic  for  Gums  and  Sensi- 
tive Dentine. 

Dr.  Martin. 

K .    Cocaine gr-X^ 

Antipyrine g^-vj 

Aq.    destil TTL^vj.   M. 

Prof.  J.  E.  Michael  suggests  2  grains 

of   acetanilid    as  a  substitute    for    the 

antipyrine. 

For  Stomatitis  and  Difficult    Teething 
of  Children. 

INTERNA!'.    KLIN.   RUNDSCHAU. 

1.  Paint  the  gums  with  the  following 
mixture : 

R.    Cocainse  mur gr.iss 

Sodii  chlor gr.xv 

Glycerini, 

Aquas  dest.  .....  aa  ^iiss. 

2.  Spray  a  boracic  acid  solution  on 
the  inflamed  parts. 

3.  To  prevent  spasms  give  internally  : 
R .    Potassii  brom gr.xv 

Syr.  alth ^v 

Salep.  gummos.   .    .    .  ^j-^ij. 
M. — S.  Teaspoonful  every  hour. 

For  Irj'itation  of  the   Gums. 

M.  F.  Besnier. 

B .    Hydrochlorate    of  co- 
caine      gr.| 

Bromide  of  potassium  .  gr.vii  ss 

Distilled  water    .    .    . 

Glycerine     .    .    .    .  aa  TTtcl.      M. 

For  Hypersensitive  Dentine. 

Dr.  D.  Genese. 

R .  Cocaine  hydrochlor.  4  per  cent. 
Carbolic  acid  ...  50  per  cent. 
Benzoin  gum    ...  50  per  cent. 


Local  Obtundent. 

Dr.  Hoff. 

R.    Cocaine g^.^ 

Atropine  (tablet)    .    .  gr.^ 
Carbolized  water  (^ 

percent.)     .    .    .    .  gtts.xxx 

Local  Obtundent  or  Ancesthetic. 


Dr.  a.  C.  Hewitt. 


R 


Cocaine  hydrochlorat .  grs.  Cxx 

Atropine gr-xV 

Straphanthin   .    .    .    .  gr.^ 
Beta  naphthol    .    .    .  gr.x 
Oil  of  cloves, 
Oil  of  cassia    .    .    .    .  aa  g  ij 

Glycerine ad  gj.     M. 

SiGNA. — Apply  for  all  operations  about 
the  gums,  as  with  an  applicator. 

Local  Anesthetic. 
Dr.  W.  T.  Martin. 


R .    Hydr.  cocaine 

.    .  grs.x 

Sulp.  atropine 

•    •    .gr-rV 

Aquse  dist., 

Listerine .    .    . 

.    .    .  aa  5  iv. 

M. 

SiGNA. — Inject   into 

surrounding 

soft 

tissues,  and  wait  5 

to  20  minutes 

Local  Obtundent. 

Dr.  C.  N. 

Peirce. 

R .    Cocaine  .    .    . 

•    •  gr-v 

Carbolic  acid  . 

.    .  grs.  XX 

Chloroform 

.    .  5ss 

Muriatic  acid  . 

•  •ni'^ 

Alcohol   .    .    . 

•    ■  3iJ- 

M. 

Local  Obtundent  for  Exposed 
Pulps,  etc. 

Dr.  Bethel. 

Carbolic  acid  (crystals)  grs.x 
Gum  camphor     .    .    .  grs.viij 
Iodoform grs.  v. 


336  DENTAL   MEDICINE. 


Local    Obtundent  for  Exposed  Pulp,  Gum  camphor    .    .    .  gr.vj 

Sensitive  Dentine,  and  about  Necks  Glycerine,  pure  .    .    .  gr.xv 

of  Teeth.  95  per  cent.  spts.  vini 

R.    Acid,  carbolic    .    ,    .   gr.xx  rect.  q.  s.  ad    .    .    .   ^ij. 

01.  sassafraa  .    .    .    .  YTl  xxx  r^r       •         n,  . 

^  por  A'ausea  from    yv earing  Plates. 

Oleate  cocaine  (4  per 

cent.) TTLxv.  R.    Cocaine grs.viij 

Syrup  tolu ^  ss 

Local  AncEstketic.  inn.-  ^  _••• 

Whiskey 5  iij 

Dr.   C.  V.   Snelgrove.  Water Oi.  M. 

R.    Cocaine  liydrochlorate  gr.v  SiGNA. — To  spray  mouth. 

Acid,  carbolic    .    .    .  gr.iv 

CocAiNUM  Phenylicum  consists  of  a  combination  of  cocaine 
and  phenyl,  the  univalent  radical,  CgHg  of  phenol.  It  is  a  light- 
colored  substance  resembling  and  of  the  consistence  of  thick 
honey.  It  melts  readily,  dissolves  in  alcohol  30  to  50 per  cent,  and 
contains75per  cent,  of  the  alkaloid  cocaine.  It  is  used  locally  in 
a  strength  of  from  one  tenth  per  cent.,  and  appears  to  possess 
the  same  qualities  of  carbolic  acid.  It  has  been  recommended 
in  the  place  of  muriate  of  cocaine, 

COLCHICUM— MEADOW   SAFFRON. 

Source. — Colchicum  root — Colchici  radix ;  Colchicum  seed 
—  Colchici  semen,  the  bulb  and  seed  of  the  Colchicum  Autum- 
nali.  Colchicum  contains  tannic  and  galHc  acids  and  an 
alkaloid  known  as  colcJiicine,  which  is  the  active  principle ; 
colchicum  also  contains  starch,  sugar  and  gum.  It  has  a  bitter 
taste,  and  imparts  its  medicinal  virtues  to  water,  alcohol,  ether; 
wine  and  vinegar  extracting  all  its  properties. 

Medical  Properties  and  Therapeutic  Uses. — Colchicum,  in 
the  forms  of  fluid  extract,  wine  and  tincture,  increases  the 
mucous  and  glandular  secretions  of  the  stomach,  intestines, 
liver,  kidneys  and  skin,  and  causes  an  increased  flow  of  saliva, 
and  also  of  urine.  A  large  dose  may  produce  heat  in  the 
epigastrium,  nausea,  vomiting,  depression  of  the  circulation, 
muscular  feebleness  and  pain  in  the  head,  large  watery  stools 
and  an  increased  secretion  of  biliary  matters.  In  poisonous 
doses  it  produces  all  the  symptoms  of  an  irritant  poison,  such 
as  acute  pain  in  abdomen,    profuse    watery  and  mucous  dis- 


COLLODION.  337 


charges,  suppression  of  urine,  cold  extremities  and  feeble 
pulse ;  also  muscular  cramps,  in  some  cases.  Colchicum  is 
principally  employed  in  gout,  when  a  quantity  sufficient  to 
shorten  the  duration  of  an  acute  attack  and  reduce  the  swell- 
ing by  an  increased  secretion  from  the  skin,  intestines  and 
kidneys,  is  only  required.  It  is  often  combined  with  an  alkali, 
such  as  aromatic  spirits  of  ammonia,  bicarbonate  of  potassium, 
or  carbonate  of  magnesia,  to  increase  its  effect.  The  active 
principle,  colchicine,  is  generally  more  efficacious  than  the 
crude  colchicum.  It  is  very  serviceable  in  rheumatic  gout 
when  combined  with  alkalies,  and  also  in  all  affections  depen- 
dent upon  a  gouty  diathesis,  such  as  constipation,  congestion 
of  the  liver,  and  headache  from  torpor  of  the  portal  circula- 
tion. It  is  now  rarely  used  in  acute  rheumatism,  but  in 
chronic  rheumatism  it  often  proves  serviceable.  Its  use  is 
indicated  in  plethora,  constipation  and  deficient  action  of  the 
liver,  kidneys  and  skin. 

Dose. — Of  the  fluid  of  colchicum  root — Extractum  Colchici 
Radicis  Fluidtun,  TVLij  to  TTLv.  Of  wine  of  colchicum  root — 
Viniim  Colchici  Radicis,  iriv  to  ITLxxx.  Of  acetous  extract  of 
colchichum  root — Extractum  Colchici  Radicis,  gr.  ss  to  gr.  ij. 
Of  tincture  of  colchicum  (seed) — Tinctura  Colchici,  TTlx  to  5j- 

COLLODIUM— COLLODION. 

Derivation. — Collodion  is  a  solution  of  4  parts  of  pyroxylin 
in  70  parts  of  stronger  ether,  and  26  parts  of  alcohol.  Pyroxy- 
lin or  gun  cotton,  is  prepared  by  adding  a  mixture  of  nitric 
and  sulphuric  acids  to  cotton  freed  from  impurities. 

Collodion  is  a  colorless,  syrupy,  and  very  inflammable  liquid, 
with  a  strong  ethereal  odor.  By  long  standing  and  exposure, 
or  when  applied  to  a  surface,  it  deposits  a  thin,  transparent 
and  strongly  contractile  film,  which  is  insoluble  in  water  or 
alcohol.  It  should  be  kept  in  glass-stoppered  bottles.  It  is 
applied  by  means  of  a  camel-hair  brush.  When  it  becomes 
too  thick,  it  may  be  diluted  by  a  solution  consisting  of  ether, 
3  parts,  alcohol,  i  part. 

Medical  Properties  and  Action. — It  is  serviceable  as  an  emol- 
22 


338  DENTAL   MEDICINE. 


lient,  and  its  action  is  mechanical,  as  it  draws  together  and 
holds  in  apposition  divided  parts,  and  protects  such,  as  well  as 
abraded  or  denuded  surfaces,  from  contact  with  the  air.  As 
the  ether  it  contains  evaporates,  the  surface  of  the  part  to  which 
it  is  applied  is  constringed,  and  a  degree  of  pressure  is  thus 
established,  which  is  very  useful  in  moderating  vascular  action, 
promoting  absorption,  and  changing  the  course  of  pus  which 
may  already  be  formed  into  a  direction  more  desirable.  On 
account  of  the  liability  of  collodion  to  crack  and  peel  off, 
these  objections  have  been  obviated  by  the  use  of  what  is 
known  as  Flexible  Collodion — Collodiuni  Flexile — (collodion, 
92  parts,  Canada  turpentine,  5  parts,  castor  oil  3  parts),  which 
is  softer  and  more  pliable  and  elastic. 

Therapeutic  Uses.  —  Collodion  is  very  useful  in  ulcers, 
fissures,  incised  wounds,  abraded  surfaces,  erysipelas,  skin  dis- 
eases, etc. 

Dental  Uses. — Collodion  is  a  very  useful  application  in  dental 
practice,  to  prevent  alveolar  abscesses  from  discharging  exter- 
nally on  the  face;  for  such  a  purpose,  it  is  applied  in  successive 
layers,  so  as  to  act  as  a  compress,  and,  by  moderating  the 
vascular  action,  cause  absorption,  or  such  a  change  in  the 
direction  of  the  discharge  as  will  induce  it  to  open  in  the  mouth. 
It  is  also  employed  in  combination  with  carbolic  acid,  as  an 
application  for  odontalgia;  when  introduced  on  cotton,  it  acts 
as  a  temporary  filling;  it  has  also  been  employed  for  arresting 
the  mucous  secretion  during  the  operation  of  filling  cavities 
near  to  or  under  the  margin  of  the  gum,  but  the  rubber  dam 
has  superseded  it  in  this  respect.  Combined  with  iron  .and 
other  agents,  it  forms  a  styptic  preparation. 

In  the  dental  laboratory,  collodion,  in  the  form  of  a  colored 
preparation,  is  employed  to  coat  the  surfaces  of  the  plaster 
models  of  plastic  work,  and  when  not  applied  too  thick,  it 
protects  the  plaster  surface,  and  also  prevents  an  unsightly 
rubber  surface  on  that  part  of  the  plate  which  is  adapted  to 
the  mucous  surface  of  the  mouth.  When  this  preparation 
becomes  too  thick  for  use,  it  may  be  diluted  with  a  solution  of 
3  parts  of  ether  to  i  part  of  alcohol. 


COLLODION.  339 


Collodion  is  precipited  by  carbolic  acid, 

Cantharidal  Collodion — Collodium  cum  Caittharide — is 
composed  of  cantharides  (Spanish  flies),  in  powder  60  parts, 
flexible  collodion,  85  parts,  commercial  chloroform,  q.  s.  The 
addition  of  one  per  cent,  of  Venice  turpentine  to  cantharidal 
collodion  will  prevent  the  disagreeable,  and,  at  times,  painful 
contraction  of  the  preparation  on  drying. 

Like  cantharides,  cantharidal  collodion,  when  locally  applied, 
excites  inflanmiation  of  the  skin  and  mucous  membrane,  which 
terminates  in  a  copious  secretion  of  serum  under  the  cuticle. 
It  produces  a  blister  in  the  same  time  as  the  ordinary  blister- 
ing plaster,  and  is  applied  with  greater  facility,  and  is  better  ' 
adapted  to  cover  uneven  surfaces,  and  retains  its  place  more . 
certainly.  It  acts  much  more  readily  if  the  evappration  of  the: 
ether  is  prevented  by  a  piece  of  oiled  silk  placed  over  the  sur- 
face immediately  after  the  application  of  the  collodion. 

Dental  Uses. — Cantharidal  collodion  is  a  valuable  application 
in  periodontitis,  applied  to  the  gum  over  the  root  of  the 
affected  tooth,  by  means  of  a  camel-hair  brush,  previously 
removing  all  moisture  from  the  surface,  and  protecting  the  lips 
and  cheeks,  until  the  ether  it  contains  has  evaporated,  and  an 
artificial  cuticle  is  formed.  The  blister  which  rises  on  the  gum 
should  be  punctured  with  a  needle.  The  counter-irritation  thus 
produced  relieves  the  periosteal  inflammation. 

Iodized  Collodion — Collodium  lodicuni — (collodion,  §j. 
iodine,  gr.  xx)  forms  a  good  solution  of  iodine  for  external  use. 

DENTAL  FORMUL/E. 

For   Odontalgia.  For  a  Styptic. 

R.    Acidi  carbolici  cryst.,  ^-    ^^^^^^^ 3"J 

Collodii aa  5J.     M.  ^^^':^-^^^']  perchloridi  3J 

SiGNA. — To  be  applied  on  cotton. 
For  a  Styptic. 

R  .    Collodii partes  100 

Acidi  carbolici  .    .  partes     10  For  a  Styptic. 

Acidi  tannici  .    .    .partes       5  R.    Acidi  tannici, 

Acidi  benzoici  .    .  partes      5.  M.  Alcoholis, 

SiGNA. — To  be  applied  to  the  bleeding  .(Etheris  .    .    .    .  aa  partes  aeq.  M. 

surface    by    means    of    a    camel-hair  Then  add  as  much  pyroxylin  as  the 

brush.  solution  will  dissolve. 


Olei  ricini gtt.ij.       M. 

SiGNA. — To  be  applied  to  the  bleeding 
surface,  or,  on  cotton,  to  the  alveolar 
cavity. 


340  DENTAL  MEDICINE. 


Crystallin  is  the  name  of  a  collodion,  in  which  methyl 
alcochol  takes  the  place  of  ethyl  alcohol.  Crystallin  differs 
from  ordinary  collodion  in  that  it  does  not  dry  so  quickly :  it 
leaves  a  thin  transparent  cuticle,  and  a  pure  article  of  methyl 
alcohol  should  be  employed  in  preparing  it  to  prevent  the  un- 
pleasant, penetrating  odor  of  impure  alcohol.  Philip  recom- 
mends the  following  formula  for  ''flexible  crystallin.'" 

R .        Castor  oil 4  parts 

Canada  balsam 2  parts 

Crystallin 40  parts. 

Crystallin  varnish,  impervious  to  air,  can  be  prepared  as 
follows  : 

R.         Crystallin 30  parts 

Castor  oil 4  parts 

Zinc  oxide 8  parts. 

CONIUM— HEMLOCK. 

Derivation. — Hemlock  is  the  fruit  of  the  Conium  maculatum, 
or  spotted  (not  the  common)  hemlock,  which  is  an  umbellif- 
erous plant.  The  principal  one  of  its  three  alkaloids  is  conine, 
CgHjgN,  which  is  very  powerful. 

Medical  Properties  and  Action. — Conium  is  a  depressing 
agent  producing  motor  paralysis,  first  causing,  as  the  effects 
of  a  large  dose,  nausea  and  vomiting  with  a  general  weakness 
of  the  voluntary  muscles,  but  with  no  direct  action  on  the 
heart.  In  fatal  cases  of  poisoning  death  follows  from  paralysis 
of  the  respiratory  muscles  causing  asphyxia.  The  antidotes 
are  nux  vomica,  picrotoxin,  and  active  muscular  exercise.  It 
is  quickly  decomposed  by  heat. 

Therapeutic  Uses. — Conium  is  employed  in  mania,  chorea, 
tetanus,  hydrophobia,  whooping-cough,  asthma,  laryngismus, 
stridulus,  diseases  of  the  eye  and  strychine  poison.  For 
nerve-pain  with  muscular  spasm,  the  best  results  may  be  ex- 
pected from  the  combined  administration  of  morphine  and 
conine,  subcutaneously  applied,  as  the  effects  of  conine  are 
greatly  heightened  by  morphine.  Conium  is  also  used  in 
dislocations  to  relax  muscles. 


CORYL.  341 

Dose. — Of  Abstractum  conii,  gr.  ss  to  gr.  ij ;  Extractum 
conii  alcoholicum,  gr.  ij  to  gr.  iv;  Extractum  conii  fluidum, 
Tixij  to  iTLv;  Tinctura  conii,  ITL^  to  foj ;  Conine,  TT^yVto  lYlij. 

Dental  Uses. — Conium   is  employed   in    neuralgia,    locally 

applied ;    inflamed    dental    pulps ;    also  in    cases    of  artificial 

teeth  lodging  in  the  oesophagus,  to  produce  relaxation  of  the 

muscles. 

CORYL. 

Derivation. — Coryl  is  a  mixture  of  chloride  of  methyl  and 
chloride  of  ethyl.  It  is  kept  liquid  under  a  pressure  of  three 
atmospheres  in  a  recipient  called  "Coryleur,"  which  is  a  small 
nickel-plated  metallic  tube,  easily  managed  with  a  stop-cock, 
which  allows  the  regulation  of  the  escape  of  the  vapor  of  the 
compound.  In  using  it,  the  tube  must  be  kept  in  a  horizontal 
position.  It  is  a  colorless  liquid  of  an  ethereal  odor  and  taste, 
and  is  obtained  by  a  methylation  of  chloride  of  ethyl. 

Therapeutic  Action. — Coryl  is  a  new  refrigerating  local 
anaesthetic,  less  powerful  than  chloride  of  methyl,  and  not  so 
liable  to  cause  an  eschar;  it  is,  however,  more  powerful  than 
chloride  of  ethyl,  and  produces  a  deeper  state  of  insensibility. 
It  is  as  inflammable  as  chloride  of  ethyl,  and  boils  at  32°  F. 
Coryl  will  produce  complete  anaesthesia  in  1 5  to  20  seconds  ; 
and  to  apply  it  the  patient  is  directed  to  breathe  by  the 
nose,  and  not  by  the  mouth ;  he  must  then  rinse  his  mouth 
with  water  at  the  temperature  of  the  room,  the  gum  must  be 
dried  and  the  jet  of  coryl  applied  to  the  mucous  membrane 
below  the  crown  of  the  tooth  to  be  extracted.  Beginning  at  the 
apex  of  the  root  and  carrying  the  jet  upward  toward  the  neck 
of  the  tooth,  then  over  the  crown,  and  down  on  the  inner  side 
of  the  alveolus  up  to  the  end  of  the  root,  then  coming  back 
again  over  the  same  parts,  and  repeating  this  for  1 5  to  20  sec- 
onds, when  the  anaesthesia  will  be  found  complete.  To  obtain 
a  deeper  and  more  prolonged  state  of  insensibility,  as  soon  as  a 
first  application  of  the  coryl  is  made,  the  mouth  must  be  quickly 
rinsed  with  water ;  then  a  second  application  is  made,  followed 
by  another  rinsing  of  the  mouth,  and  finally  a  third  application, 
when  the  anaesthesia  will  be  found  to  last  over  40  minutes. 


342  DENTAL   MEDICINE. 


CREASOTUM— CREASOTE. 

Specific  Gravity.   1.08. 

Derivation. — Creasote  is  a  product  of  the  distillation  of  wood- 
tar,  and  is  a  mixture  of  several  phenols,  such  as  carbolic  acid, 
creasol,  CgHjoOj,  and  cresylol,  QHgO.  Its  name  is  derived 
from  the  Greek  Kpz6.%^  "flesh,"  and  oioxrj'z,  "preserver,"  as 
animal  substances,  when  saturated  with  it,  are  preserved 
from  putrefaction.  It  is  also  obtained  from  crude  pyrolig- 
neous  acid.  When  derived  from  wood-tar,  creasote  principally 
consists  of  such  phenols  as  guaiacol,  creasol,  methyl-creasol, 
and  phloral.  The  best  form  of  creasote  for  medicinal  use  is 
made  from  beech-wood. 

Creasote,  when  fresh  and  pure,  is  a  colorless,  oleaginous 
fluid,  with  a  strong  empyreumatic  odor,  resembling  closely 
carbolic  acid,  and  a  caustic,  burning  taste ;  when  made  from 
beech-wood  creasote  is  of  a  reddish,  amber  color.  After  expo- 
sure, it  has  a  yellowish  or  brownish  tinge.  Its  purity  may  be 
tested  by  strong  acetic  acid,  which  dissolves  the  creasote, 
and  leaves  behind  the  impurities  floating  above  the  creasote 
solution.  It  may  also  be  tested  by  dropping  it  on  paper,  when, 
if  pure,  it  will,  after  being  volatilized  by  heat,  leave  no  stain. 
Creasote  may  be  distinguished  from  carbolic  acid,  which  it 
closely  resembles  in  many  respects,  in  being  less  caustic,  and 
by  not  imparting  a  blue  color  to  a  piece  of  pine  wood  dipped 
first  into  an  alkaline  solution  of  creasote,  and  then,  after  drying, 
into  muriatic  acid. 

Combined  with  the  tincture  of  the  chloride  of  iron,  an 
alcoholic  solution  of  creasote  will  develop  a  deep,  greenish -blue 
color,  while  carbolic  acid  with  the  same  tincture  produces  a 
light  brown.  According  to  the  U.  S.  Dispensatory,  creasote 
powerfully  coagulates  albumen. 

Medical  Properties  and  Action. — Creasote  is  stimulant, 
sedative,  rubefacient,  escharotic,  styptic  and  antiseptic.  It 
possesses  the  property  of  immediately  coagulating  albumen, 
and  to  this  property  is  ascribed  many  of  its  effects  on  the 
living  system.     In  large  doses  it  is   an  acro-narcotic  poison ; 


CREASOTE.  343 


but  in  small  doses,  it  is  styptic  and  astringent,  and  for  the 
latter  property  it  is  more  generally  administered  than  for 
any  other.  When  creasote  comes  in  contact  with  the  blood, 
the  latter  changes  from  a  bright  red  to  a  reddish-brown 
color,  with  small  spots  of  coagulated  albumen  and  also 
becomes  thicker.  Applied  to  the  tongue,  it  causes  severe 
pain,  but  without  redness  or  tumefaction  ;  it  also  causes  a 
strong  taste  of  smoke,  and  a  copious  flow  of  saliva.  When 
administered  internally  in  small  doses,  it  causes  a  sensation  of 
warmth  in  the  stomach,  and  exercises  a  decided  sedative  action. 
In  large  and  poisonous  doses  it  produces  profound  stupor, 
flushed  countenance,  fixed  eyes,  slow  and  labored  pulse,  irri- 
table stomach,  nausea,  vertigo,  but  has  no  effect,  such  as  dila- 
tation or  contraction,  on  the  pupils.  The  treatment  in  cases  of 
poisoning  by  creasote  consists  in  administering  albumen,  such 
as  white  of  eggs,  milk,  or  wheat  flour ;  also  the  administration 
of  ammonia  and  other  stimulants,  mustard,  emetics,  etc.  Death 
from  creasote  is  caused  by  its  coagulating  the  albumen  of  the 
blood,  and  preventing  its  circulation  through  the  arterial 
system. 

Therapeutic  Uses. — Creasote  is  administered  internally  for 
gastric  irritability  and  vomiting,  flatulence,  diarrhoea,  diabetes, 
haemoptysis,  pulmonary  consumption,  chronic  bronchitis,  epi- 
lepsy, neuralgia,  etc.  Externally,  it  is  applied  to  ulcers, 
eruptions,  diseases  of  the  skin,  wounds,  hemorrhage  from 
wounds  or  leech  bites,  warts ;  also  in  putrid  sore  throat,  as  a 
gargle. 

Dose. — Of  creasote,  gtt,  j  or  gtt.  ij,  several  times  a  day,  either 
in  mucilage,  in  the  proportion  of  half  a  fluid  ounce  to  a  drop 
of  the  creasote;  or  it  may  be  given  in  pill  form.  For  external 
use,  from  gtt.  ij  to  gtt.  vj,  or  more  may  be  added  to  a  fluid 
ounce  of  water. 

Creasote  Water. — AqucE  Creasoti  (creasote,  5j,  distilled 
water,  Oj).     Dose  of  creasote  water,  f5j  to  f5iv. 

Solidified  Creasote. — For  the  purpose  of  making  the 
application  of  creasote  to  the  teeth  more  convenient,  and  pre- 
venting the  effects  upon  the  mucous  membrane  of  the  mouth 


344  DENTAL  MEDICINE. 


when  applying  it  to  carious  cavities  in  teeth,  a  gelatinous  solid- 
ity may  be  given  to  it  by  adding  lo  parts  of  collodion  to  15 
parts  of  creasote. 

Dental  Uses. — Creasote,  like  carbolic  acid,  is  a  valuable  agent 
in  dental  practice,  although  the  use  of  the  latter  has,  in  some 
respects,  superseded  that  of  the  former,  the  two  being  very 
similar  in  their  action,  with  some  advantages  in  the  case  of 
carbolic  acid.  Creasote  is  employed  for  the  relief  of  odontal- 
gia, obtunding  the  sensitiveness  of  dentine,  alveolar  abscess, 
periodontitis,  suppurating  pulps  of  teeth,  devitalizing  pulps 
of  teeth,  treatment  of  exposed  pulps  of  teeth,  mercurial,  and 
other  forms  of  stomatitis,  ulcers  of  the  mouth,  diseases  of  the 
gums  ;  as  a  styptic  for  hemorrhage  from  the  gums,  mucous 
membrane  and  leech  bjtes,  and  after  the  extraction  of  teeth. 
Creasote,  like  carbolic  acid,  has  a  peculiar  power  as  an  anti- 
septic, hence  it  is  a  valuable  application  in  cases  attended  with 
offensive  purulent  discharges.  It  promotes  the  growth  of 
healthy  granulations,  and  hastens  the  healing  of  wounds,  and 
arrests  the  process  of  suppuration.  Properly  diluted  in  the 
form  of  a  gargle,  creasote  in  sloughs  of  the  mouth  or  throat 
stimulates  the  ulcer  to  healing  and  corrects  fetor  of  the  breath. 
When  applied  to  ulcerated  surfaces,  it  should  be  repeated  as 
pus  is  formed,  or  fungous  growths  appear.  It  is  a  painful 
escharotic  upon  mucous  membrane,  with,  however,  a  soothing 
reaction.  An  ointment — Unguentmn  Creasoti — is  composed 
of  creasote,  fSss,  lard,  .Sj,  and  is  useful  in  cutaneous  affections. 

For  the  treatment  of  exposed  pulps  it  is  employed  either 
diluted  or  in  its  full  strength  ;  for  periodontitis  and  alveolar 
abscess,  in  its  full  strength,  or  in  combination  with  such  agents 
as  glycerine,  iodine,  etc. ;  also  in  devitalized  teeth,  and  as  an 
antiseptic  application  in  ulceration  of  the  mouth,  and  reces- 
sion of  gums  from  the  neck  of  the  teeth.  When  used  as  a 
styptic  after  the  extraction  of  teeth  it  is  applied  on  lint  or  cot- 
ton, with  pressure ;  and  diluted  with  water  it  is  employed  in 
the  treatment  of  caries  and  necrosis  of  the  maxillary  bones. 
To  dilute  it  for  injections  it  "is  often  mixed  with  alcohol,  and 
the  strength  reduced  by  adding  water.     Mixed  with  an  equal 


CREASOTE.  345 


quantity  of  oil  of  cloves  its  odor  and  taste  are  modified.     Cre- 

asote  is  also  employed  to  neutralize  any  acid  remaining  in  the 
cavity  of  a  tooth  about  to  be  filled,  and  to  harden  and  render 
imperishable  the  contents  of  the  dentinal  tubuli,  for  which 
purpose  it  is  applied  to  the  walls  of  the  cavity  on  a  pellet  of 
cotton.  Equal  quantities  by  bulk  of  creasote  and  oil  of  cloves 
are  applied  to  aching  teeth,  painful  gums,  ulcerous  surfaces, 
and  also  where  pulps  are  not  exposed  ;  also  for  saturating 
cavities  before  the  insertion  of  fillings,  as  a  disinfectant  and 
coagulant. 

DENTAL    FORMULA. 
For  Pulpilis.        ■  For   Odontalgia . 


Garretson. 


R  .    Creasoti ^  ij 

Morphinse  acetatis .    .   gr.xx.      M. 
R.    Creasoti gtt.vj  SiGNA.— To   be  applied,  on   cotton,  to 


Tinct.  iodinii  .    .    ,  .  5J  carious  cavity. 

Liq.  plumb,  subacet.  .    'ZS                                            t^       ^  ,     ,   r   ■ 

^  '^  ''■'                                           For  Oaojitalgja. 
Chloroformi 


Tinct.  opii  .    .    .  aa  ^ss.        M. 
SiGNA. — Apply   on    cotton  to  exposed 


R .    Creasoti, 

Chloroformi, 


For  Alveolar  Abscesses. 


Liquidi  opii    .    .    .    .  aa  ^  iij 

surface  of  pulp.  t--     ^        u         •   •  '•'  •      at 

^     ^  Tmctura  benzomi  .    .         5J.     M. 

SiGNA. — To  be  applied  on  a  pellet  of 

cotton,  to  carious  cavity. 

R.    Creasoti,  j?or  Odontalgia. 

Linimenti  iodi,  partes  asquales.  M.        U  _    Creasoti 

SiGNA. — To  be  used  as  an  injection.  Chloroformi, 


For  Odontalgia. 


Morphinae  hydrochlo- 

ratis.    ...     ,    .    .  aa  ,^iij 

R.    Creasoti gss  Tinctura  benzoini   .    .        5J.      M. 

Camphorse gr.x.         M.        SiGNA. — To  be  applied,  on  a  pellet  of 

SiGNA. — To  be  applied,  on  a  pellet  of  cotton,  to   carious  cavity.     (See   for- 

cotton,  to  carious  cavity.  mulse  of  Carbolic  Acid.) 

GuAiACOL  is  a  derivation  of  wood  creasote,  in  the  form  of  an 
oily  liquid  with  an  odor  of  cassia  and  resorcin. 

The  liquid  guaiacol  found  in  commerce  is  far  from  being 
almost  a  chemically  pure  product.  It  is  a  mixture  of  cresylol, 
guaiacol,  and  creasote  in  varying  proportions.  It  may  contain 
50  per  cent,  guaiacol,  but  sometimes  it  contains  no  more  than 
20  or  even  10  per  cent.  Pure  guaiacol  is  in  the  form  of  hard, 
white  rhomboidal  crystals,  almost  insoluble  in  water,  but 
soluble  in  alcohol,  in  oil,  and  in  anhydrous  glycerine. 


346  DENTAL   MEDICINE. 


The  taste  of  guaiacol  is  slightly  sweetish,  with  a  pungent 
and  burning  after-taste.  The  chief  effects  of  poisoning  with 
pure  guaiacol  are,  agitation  and  than  enfeeblement  with  retard- 
ation of  the  heart's  action,  and  of  the  breathing.  Most  of  the 
secretions,  and  especially  the  lachrymal,  are  increased  in 
quantity.  Death  occurs  during  coma.  Synthetic  guaiacol 
has  been  administered  in  various  stages  of  consumption  taken 
immediately  before  eating.     Large  doses  may  cause  vomiting. 

The  oily  liquid  possesses  the  active  principle  of  creasote,  and 

the  power  to  destroy  microbes   in   the   human   mouth.     It  is 

claimed  to  possess  the  same  therapeutic  value  as  creasote  and 

to  be  a  better  disinfectant,  especially  in   cases  of  decomposed 

pulps.    "Guaiacol  may  be  sealed  up  in  a  pulp  cavity  from  one 

to  three  months  or  more,  and  the  contents  be  found  perfectly 

disinfected." 

CREOLIN— CREOLINE. 

Creolin  is  a  product  of  the  decomposition  of  coal  tar. 

Derivation. — It  is  obtained  from  English  pit-coal  by  distilla- 
tion, and  is  in  the  form  of  a  brownish,  syrupy  liquid,  complex 
and  very  impure,  with  an  odor  like  tar ;  and  in  its  impure  state 
is  slightly  irritating,  slightly  caustic  and  strongly  acid,  and 
resembles  in  its  properties  the  phenols.  A  purified  preparation 
of  creolin  is,  however,  as  neutral  as  vaseline,  and  quite  as  in- 
offensive to  man  and  animals.  It  is  insoluble  in  water,  but 
soluble  in  ether,  chloroform,  and  absolute  alcohol.. 

Therapeutic  Uses  and  Medical  Properties, — Creolin  is  both 
antiseptic,  germicide  and  haemostatic,  being  employed  for  the 
latter  purpose  in  obstetrical  practice ;  it  is  also  employed  in 
tonsillitis.  It  is  employed  with  great  benefit  in  ulcers  of  the 
cornea.  Its  germicidal  powers  are  said  to  be  ten  times 
superior  to  those  of  carbolic  acid,  and  its  action  on  the  spores 
is  even  more  pronounced  than  corrosive  sublimate.  The  addi- 
tion of  from  eight  to  ten  drops  of  a  three  per  cent,  aqueous 
solution  is  sufficient  to  completely  sterilize  and  prevent  the 
development  of  the  comma-bacillus,  and  from  one  to  three 
drops  of  a  one  per  cent,  solution  will  retard  the  development 
of  the  micro-organisms,  and  four  drops  will  prevent  it  com- 


PREPARED   CHALK.  347 


pletely.  Its  antiseptic  properties  are  said  to  be  superior  to  all 
other  drugs  at  our  command.  It  is  soluble  in  water,  alcohol 
and  glycerine,  and  it  does  not  affect  the  skin  nor  corrode  in- 
struments, and  the  odor  of  the  purified  preparation  is  not  dis- 
agreeable. It  appears  to  have  an  anodyne  effect,  and  is  cura- 
tive when  applied  to  open  wounds.  Creolin  has  also  been 
employed  in  antral  disease.  An  aqueous  solution  of  creolin 
is  made  of:  I^.  Creolin,  gr.  iss;  aquae  destil.,  1Tlcl,  which  may 
be  applied  with  a  brush  or  in  the  form  of  spray.  For  dental 
use  it  may  be  injected,  or  applied  on  floss-silk  or  cotton  wool. 
Creolin  is  considered  to  be  a  good  deodorizer  of  iodoform. 
One  or  two  drops  of  creolin  may  be  added  to  half  a  glass  of 
water  for  a  mouth-wash,  to  correct  disagreeable  odors  from 
the  teeth  and  mouth.  It  will  also  hold  in  check  acid-produc- 
ing germs;  it  is  also  recommended  for  its  action  on  mucous 
surfaces  in  soft  and  congested  mouths,  and  to  correct  acid 
conditions,  and  the  treatment  of  fistulous  tracts  of  suppurating 
surfaces;  also  in  root  canals  to  deodorize  dead  tissue.  It 
will  also  remove  the  rust  on  instruments  when  applied  by 
means  of  a  felt  wheel  of  a  lathe.  To  sterilize  instruments  a 
two  per  cent,  solution  may  be  used;  also  on  the  hands,  and  a 
one  per  cent,  solution  for  irrigation  of  wounds  and  treatment 
of  mucous  surfaces. 

DENTAL    FORMULiE. 

For  Alveolar  Pyorrhcea. 

Dr.  a.  W.  Harlan. 
R.        Creolin ^i^j 

Sodium  fluo.  silicate    .    .    .    *    • gr.xx 

Olei  cassise HXxx 

Glycerinse ^iv.  M. 

Dilute  with  water  to  suit. 
SiGNA. — Use  as  a  mouth- wash  on  a  soft  brush,  during  the  intervals  between 
sittings  when  escharotic  and  antiseptic  agents  have  been  applied. 

CRETA  PR.EPARATA— PREPARED  CHALK. 
PRECIPITATED  CHALK,  CARBONATE   OF  LIME. 

Fonmtla. — CaCOg. 

Derivation. — Prepared  chalk  is  obtained  by  freeing    chalk 
from  such  impurities  as  gritty  and  flinty  substances  and  solu- 


348  DENTAL   MEDICINE. 


ble  saline  matter,  by  elutriation,  and  afterward  drying   it.     It 
is  the  only  form  in  which  chalk  is  used  medicinally. 

Medical  Properties  and  Action. — Prepared  chalk  is  antacid, 
absorbent  and  astringent  It  diminishes  the  secretion  of  the 
mucous  membrane,  and  at  the  same  time  acts  as  an  antacid  in 
correcting  any  acidity  present.  When  internally  administered 
for  a  considerable  time,  like  magnesia,  it  accumulates  in  the 
bowels  and  forms  intestinal  concretions ;  hence  an  occasional 
aperient  is  necessary. 

Therapeutic  Uses. — Prepared  chalk  is  an  excellent  antacid 
in  diarrhoea  from  acidity,  in  acidity  attending  dyspepsia  and 
gout,  chronic  bronchitis  in  advanced  stages,  rachitis,  etc. 
Externally,  it  is  employed  in  the  treatment  of  ulcers,  burns, 
excoriations  and  skin  diseases.  It  moderately  stimulates 
ulcers  and  absorbs  the  discharge,  thus  preventing  them  from 
spreading. 

It  is  an  antidote  for  poisoning  by  oxalic  and  most  of  the 
vegetable  and  mineral  acids. 

Dose. — Of  prepared  chalk,  gr.  v  to  3j,  in  powder  or  sus- 
pended in  water  by  the  aid  of  mucilage  and  sugar. 

Chalk  Mlxture — Mistura  Cretcs — (prepared  chalk,  Sss  ; 
acacia,  gr.  cxx  ;  water,  f§iv)  is  often  combined  with  opiates 
and  astringents,  such  as  laudanum  and  tincture  of  kino  or  o* 
catechu,  in  the  treatment  of  diarrhoea.     Dose,  5j  to  Sss. 

Dental  Uses. — Prepared  chalk  is  used  in  dental  practice 
chiefly  for  its  antacid  property,  and  generally  as  an  ingredient 
of  dentifrices ;  it  is  also  employed  in  the  form  of  powder  as 
an  antacid  in  acidity  of  the  oral  fluids,  for  which  purpose  it  is 
rubbed  between  the  teeth  and  permitted  to  remain  during  the 
night;  it  is  also  employed  to  obtund  the  sensitiveness  of 
dentine,  on  account  of  its  absorbent  and  antacid  properties ; 
for  such  a  purpose  it  should  be  applied  repeatedly,  for  several 
days,  to  the  sensitive  surface.  In  the  dental  laboratory  it  is 
used  as  a  polishing  powder  for  metal  and  plastic  work ;  also 
for  polishing  the  surfaces  of  gold  fillings.  The  precipitated 
chalk  of  the  Pharmacopoeia  is  the  preparation  to  be  preferred, 
on  account  of  its  freedom  from  gritty  particles. 


PREPARED   CHALK. 


349 


DENTAL 
Dentifrice  in  the  form  of  Troches. 


li .    Cretae  preparata; . 


Ib.iv 

Ib.iss 
gtt.xxx 

5X. 


Sodii  boratis  (pulv. 
Saponis  Castil.  " 
Sacch.  albae  " 
Ossis  sepiae  " 
Olei  rosse  .  .  . 
Millefleurs  .  .  . 
Essentiae  jasmin  . 
Mix  with  a  solution  of  gum  syrup. 

Dentifrice  in  the' for rn  of  Camphorated 

Paste. 

Keller  Medicine  Co. 

Pts.  by  Wt. 
R  •  Magnes.  carb. 
Glycerini  .  . 
Potas.  chlorat. 
Tr.  camphora . 
Ol.  gaultheriae 
Cretse  prsep,    . 


FORMUL/E. 

Dentifrice. 

R.    Pulv.  radicis  iridis  . 

Ibss 

Cretse  prseparatK     . 

•   3'^ 

Sodii  carb 

,^ss 

Pulv.  cinchonse  .    . 

^iv 

Pulv.  sacchari  albi .    . 

.^i) 

Pulv.  myrrhse .    .    . 

Z) 

Pulv.  ossis  sepiae    . 

SiJ 

Otto  rosse     .... 

gttiv 

To  make  desired  number  of  parts. 

Syr.  simplic q.  s.  M. 

To  make  a  thick  paste. 

Dentif-ice. 
Am.  Dent.  Association. 


With  rose  pink,  q.  s.  to  color. 

Dentifrice  in   the  form    of   Glycerine 
Tablets. 

Keller  Medicine  Co. 

Pts.  by  Wt. 

R  •    Solut.  magnes.  carb.  .  2 

"       sodii  bicarb .    .  I 

"      potas.  chlorat. .  3 

"       sapo.  cas.  albi.  6 

Glycerini i 

Cal.  carb 10 

01.  gautheria, 

Cassias aa  q.  s.    M. 

To  flavor. 

Dentifrice. 


R. 


CretEe  pr^paratse    . 

Bbiij 

R. 

Cretae  prtep.    .    .    . 

5''J 

Pulv.  cinchonse   .    . 

Ibj 

Pulv.  radicis  iridis  . 

.^ii 

Pulv.  radicis  iridis 

ftj 

Pulv.  sacchari  albi 

Pulv.  sacchari  albi  . 

Ibiss 

Pulv.  cinnamon  .    . 

.^'ij 

Pulv.  saponis  cas.  . 

3J 

Pulv.  saponis  cas.  . 

.^ij 

Sodi  carb 

5J 

Pulv.  myrrhse .    . 

7,\ 

Olei  sassafras  .    .    . 

gtt.lxxx. 

01.  gaultheriae     .    . 

gtt.x 

M. 


Dentifrice. 
Am.  Dent.  Association. 

R .    Cretse  prsep fbiij 

Pulv.  cinchonse  ...    Ibj 
Pulv.  radicis  iridis  .    .   Ibj 
Pulv.  sacchari  albi  .    .   Ibiss 
Pulv.  saponis  cas.  .    .   5J 

Sodii  carb 5J 

Glycerini fo''J 

Mellis q.  s. 

And  form  into  a  paste. 


Dentifrice. 
A.  W.  Harlan. 
R .    Crets  prseparatas, 

Pulv.  radicis  iridis  .  aa   "^  ij 
Pulv.  saponis  cas., 
Pulv.  sodii  biboratis  aa  ^ss 
Pulv^  myrrha; ....     5  ij 
Mellis  et  glycerini  .    .     q.  s. 
To  make  i  soft  paste. 
Color  rose  pink.     Perfume  to  suit. 


350 


DENTAL  MEDICINE. 


Dentifrice. 

Chapin  a.  Harris. 

R .    Cret^  preparatse    . 

^iv 

Pulv.  radicis  iridis  . 

^iv 

Pulv.  cinnamon  .    . 

giv 

Sodii  carbonatis  exsic 

catae 

3SS 

Pulv.  sacchari  albi  . 

•  IS 

Olei  limonis    .    .    . 

gtt.xv 

Olei  rosse         ... 

.   gtt.ij. 

SiGNA. — Ingredients  to  be    thoroughly 

pulverized  and  well  mixed. 

Dentifrice. 

R .    Cretse  prseparatse    . 

R)iss 

Pulv.  sodii  boratis, 

Pulv.  radicis  iridis  .  aa  Ibss 

Semen  cardamom.  . 

IS 

Pulv.  sacchari  albi  . 

Ibss 

Otto  rosse    .... 

q.  s.        M. 

To  flavor. 

Dentifrice. 

W.  D.  Miller. 

R .    Precipitated  carbonate 

of  calcium   .    .    . 

gi»X 

Cinchona  bark    .    . 

3  XV 

Prepared  oyster  shell 

3  XV 

Powd.  myrrh.  .    .    . 

3^">^ 

"      cloves    . 

3"JJ^ 

Oil  of  cinnamon  .    . 

gtt.   X  to  XV 

Mix  well. 

Dentifrice  in  the  fortn  of  a  Paste  for 

.  Compressible   Tubes. 

Keller  Medicine  Co. 

Pts.  by  Wt. 
R .    Magnes.  carbonat.  .    .     2 

Sodii  bicarb 3 

Potas.  chlorat. 

Calcii  carbonat. 

Sapo.  cas.  pulv. 

Glycerini     .    . 

Olei  gaultherias, 

Olei  limonis   .    .    .  aa  q.  s. 

Syr.  simplic q.  s. 

SiGNA. — To  make  a  paste. 


5 

20 

6 

I 


J^or  Fetor  of  Breath. 

MiLLIRON. 

R.    Sulphur,  powd., 

Creta  prep.  pulv.    .  aa.  ^] 
Spts.   rectificatus    .    .   ^jss 

Aquffi  distil ^  iij 

Peppermint      .    .    .    .    q.  s.         M. 
SiGNA. — After    removal    of    all    calcic 
deposits,     use    with     a    tootL-brush 
morning  and  evening. 

Dentifrice. 
Dr.  Darby. 
R .    Cretse  prseparatae    .    .  ^  viij 
Pulv.  radicis  iridis  .    -  ^  iv 
Pulv.  ossis  sepias    .  ■. 
Pulv.  sacchari  albi  ,    . 
Saponis  castil.    .    .  aa  ^j 

Sodse  bicarb ^  ss 

Pulv.  cinchonse  flava.  ^j 

Cochineal ^j 

Olei  rosse gtt.xx.    M. 

Rose  Dentifrice. 
R .    Cretas  praeparatse    .    ,  ^  xv 
Pulv.  saponis  .    .    .    .   ^j 

Saccharin gr.x 

Thymolis gr.xv 

Camphorge gr.xxx 

Vanillin gr.v 

Olei  rosae g't.vj.      M. 

Rub  the  camphor  and  thymol  to- 
gether in  a  mortar,  and  warm  gently  so 
a,s  to  render  the  mixture  liquid;  then 
add  the  chalk  in  small  portions  at  a 
time,  reserving  about  one  ounce ;  next 
add  the  other  ingredients,  the  perfumes 
being  first  separately  rubbed  with  the 
remainder  of  the  chalk. 

Dentifrice,  Antacid,    Tonic  and  Anti- 
septic. 

R .    Cretse  prasparatse    .    .  ^  iv 
Quininse  disulph.    .    .   gr.iv 
Pulv.  ossis  sepiae  ,    .  ^iv 
Otto  rosae gtt.iv.     M. 


CROTON-CHLORAL   HYDRATE. 


351 


Dentifrice. 
Dr.  a.  W.  Harlan. 
R .    Cretse  prseparatse    .    . 

Pulv.  radicis  iridis  .  aa  "^  iij 
Resorcin  ....'..   "^i 

Saccharine gr.v 

Pulv.  ossis  sepise    .    .  .^j 
Olei  menthse  piperitae  .  TTlv. 


Glycerine  sufficient  to  determine  its 
consistence. 

Rose  Dentifrice. 

British  Journal  Dental  Science. 


M. 


SiGNA. — Use    on    a    brush    moistened 
with  tepid  water. 

Dentifrice. 
Dr.  a.  W.  Harlan. 
R .     Cret^  prseparatse         •    ^  iij 
Sodium  fluo.  silicate  .   ^ss 
Acidi  tannici  ....    gr.xxx 
Pulv.  sacchari  albi .    .   ^jss 
Pulv.  ossis  sepiae     ,    .   ^  ss 
Olei  gaultherix  .    .    .  TTtx.        M. 
To  make  a  paste  of  the  above,  add 
glycerine  2  parts  and  honey  i  part. 

Cream  Dentifrice. 
Dental   Office    and  Laboratory. 
R .    Castile    soap,    in    fine 

powder %  oz. 

Prepared  chalk    .    .    .     i  oz. 
Oil  of  rose  geranium  .    8  drops. 


R  .  Precipitated  chalk  . 
Prepared  chalk  .  . 
Powdered  orris  .  . 
Essence  of  vanilla . 
Tincture  couniarin  . 
Tincture  benzoin  . 
Ammonia  (stronger) 

Carmine 

Oil  of  cloves  .    .    . 
Glycerine    .... 
Or  a  sufficiency. 


.5^y 

5^j 

3^j 

5»J 

3^-J 

H"J 

Z] 

3i 


Citroleine  Dentifrice. 
Dental  Office  and   Laboratory. 


R. 

Precipitated  chalk  . 

ftj 

Powdered  sugar     . 

,VJ 

Powdered  orris  root 

.?iv 

Cuttle-fish  bone  .    . 

.^ij 

Bicarbonate  of  soda 

.^i] 

Oil  of  lemon    .    .    . 

5iJ- 

M- 


Dentifrices  may  be  pleasantly  flavored  with  wintergreen, 
cassia,  sassafras,  lemon,  peppermint,  anise,  lavender,  penny- 
royal, cloves,  calamus,  attar  of  roses,  oil  of  neroli,  oil  of  rose 
geranium,  etc.  Cochineal  coloring  in  small  quantity  will 
impart  a  pink  color  to  a  dentifrice. 

CROTON— CHLORAL  HYDRATE. 
BUTYL— CHLORAL    HYDRATE. 

Formula. — C4H5CI3O.H2O. 

Z^mz'i«//<?;^— Croton-chloral  Hydrate  is  obtained  by  the 
action  of  chlorine  upon  aldehyde.  It  is  in  the  form  of  small, 
brilliant,  white,  silvery  crystals  of  a  sweetish  taste,  like  that  of 
melons.  It  is  slightly  soluble  in  water,  and  resembles  hydrate 
of  chloral  in  its  hypnotic  effects ;  but  its  action  in  this  respect 
is  not  so  powerful,  nor   ^o  certain.     It  differs  from  hydrate  of 


352  DENTAL   MEDICINE. 


chloral  in  the  singular  property  of  causing  anaesthesia  of  the 
head.  To  relieve  pain  and  induce  sleep,  the  best  effects  are 
obtained  from  a  combination  of  the  two  agents. 

Medical  Properties  and  Action. — It  is  a  sedative,  hypnotic 
and  anaesthetic.  It  resembles  chloral  hydrate,  but  is  not  so 
certain  in  its  effects  as  a  hypnotic.  Its  action  commences  in  the 
head  and  face.' 

Therapeutic  Uses. — Croton-chloral  hydrate  is  highly  recom- 
mended in  dysmenorrhoea,  sciatica,  chronic  cough,  and  in 
neuralgia  as  an  anodyne.  One  or  two  grains  will  relieve 
severe  neuralgia  of  the  fifth  pair  of  nerves  ;  it  is  frequently 
necessary,  however,  to  administer  from  five  to  fifteen  grains, 
but  it  is  not  safe  to  exceed  this  amount  at  one  time.  Croton 
chloral  in  five  or  ten  grain  doses,  in  pill  form,  administered 
three  times  a  day,  often  relieves  facial  neuralgia.  The  dose 
should  be  diminished  after  two  or  three  days  to  five  grains  or 
less  as  occasion  demands. 

Dose. — Of  croton-chloral  hydrate,  gr.  j  to  gr.  x ;  as  an 
anaesthetic,  gr.  xv,  dissolved  in  warm  water. 

Dental  Uses. — It  is  employed  with  effect  in  facial  neuralgia, 
in  doses  of  from  two  to  five  grains  every  hour  or  two,  until 
fifteen  grains  have  been  taken;  also  as  a  sedative,  in  doses  of 
from  three  to  five  grains,  in  periodontitis,  pulpitis,  etc.,  etc. 

DENTAL    FORMULA. 

For  Neuralgic   Odontalgia. 

Von  Kirchbauer. 

R.        Croton  chloral 3J 

Glycerini 3^1 

Aquse  destill ^  iiss 

Syr.  aurantii 3^^ 

Oleum  foeniculse gtt-vj.         M. 

Sign  A. — A  tablespoonful,  and  if  pain  continues  severe,  repeat  the 
dose  in  an  hour. 

CUPRI   SULPHAS— SULPHATE   OF   COPPER. 
BLUE  VITRIOL,   BLUE  STONE. 

Formula. — CUSO4+3H2O. 

Derivation. — Sulphate  of  Copper  is  obtained  by  roasting 
the  native  sulphuret,   or  by  the  combination  of  oxide  of  cop- 


SULPHATE   OF   COPPER.  353 


per  and  sulphuric  acid,  filtering  and  crystallizing.  It  is  in  the 
form  of  blue  prismatic  crystals  which,  after  exposure  to  the 
air,  effloresce  to  a  slight  degree,  and  become  covered  with  a 
greenish-white  powder.     It  has  an  astringent,  metallic  taste. 

Medical  Properties  and  Action. — Sulphate  of  Copper  is 
emetic,  tonic,  nervine,  stimulant  and  astringent,  and  is  quite 
soluble  in  water,  but  insoluble  in  alcohol.  It  is  a  prompt  and 
efficient  emetic,  the  emesis  commencing  a  few  minutes  after 
it  reaches  the  stomach,  and  the  copper  comes  up  with  the 
vomited  matter.  Little  or  no  depression  follows  its  adminis- 
tration as  an  emetic,  and  it  is  especially  adapted  to  cases  of 
narcotic  poisoning. 

Therapeutic  Uses. — Sulphate  of  Copper  is  employed  as  a 
prompt  and  efficient  emetic  in  cases  of  poisoning  ;  it  is  also 
administered  in  intermittent  fever,  neuralgia,  diarrhoea,  dysen- 
tery, croup,  epilepsy,  hysteria,  etc.,  etc.  Externally  it  is  ap- 
plied in  ulcerative  and  gangrenous  affections,  superficial 
hemorrhage,  leucorrhoea,  gonorrhoea,  ringworm,  purulent 
ophthalmia,  mucous  discharges,  diseases  of  the  skin,  indolent 
ulcers,  fungous  granulations,  warts,  etc. 

Dose. — Of  sulphate  of  copper  as  an  emetic,  gr.  iij  to  gr.  v; 
or  dissolve  20  grains  in  two  ounces  of  distilled  water  and 
give  a  tablespoonful  every  15  minutes  until  vomiting  oc- 
curs. For  internal  use  other  than  emetic  the  dose  is  gr.  ^ 
to  gr.  ss.  in  pill. 

Dental  Uses. — Sulphate  of  copper  is  employed  in  dental 
practice,  in  the  form  of  the  ammoniacal  solution,  for  long- 
standing cases  of  neuralgia ;  and  externally  it  is  applied  to 
ulcers  of  the  mouth,  cancrum  oris,  aphthous  ulceration, 
ulceration  of  the  gums  and  mucous  membrane  of  the  mouth, 
hemorrhage  from  leech  bites,  fungous  growths  of  the  gums, 
etc.,  etc. 

Dr.  Templeton  recommends  powdered  sulphate  of  copper 
for  suppurating  teeth,  applying  it  on  a  stick  of  wood  which  is 
wet  and  dipped  in  the  powder,  which  is  thus  thoroughly  ap- 
plied to  the  diseased  parts  ;  the  mouth  is  then  rinsed  with  tinct. 
of  gaultheria  or  tinct.  of  krameria. 
23 


354  DENTAL  MEDICINE. 

ELECTROZONE. 

Derivation. — Electrozone  consists  of  a  fluid  which  is  nothing 
but  sea  or  salt  water  subjected  to  an  electrolytic  current.  It 
is  a  clear  liquid,  neutral  in  reaction,  with  the  odor  of  free 
chlorine,  and  a  disagreeable,  salty  taste.  It  was  discovered  by 
A.  E.  Woolf,  who  has  succeeded  in  sterilizing  polluted  water 
with  it  on  a  large  scale. 

Properties  and  Dental  Uses.—rJyx.  C.  F.  W.  Bodecker  recom- 
mends electrozone  as  an  efficient  antiseptic,  and  claims  that  it 
has  given  him  uniformly  satisfactory  results  in  the  treatment 
of  purulent  pulpitis.  His  method  is  to  open  the  pulp-chamber 
freely,  and  then  syringe  with  tepid  water.  The  electrozone 
is  then  introduced  into  the  pulp-chamber  on  a  small  piece  of 
cotton  saturated  with  it,  followed  by  one  or  two  smaller 
pledgets  moistened  with  the  electrozone.  The  patient  is  then 
directed  to  renew  only  the  last  piece  of  cotton,  from  three  to 
five  times  daily,  or  at  least  after  every  meal,  using  the  pre- 
caution to  rinse  the  mouth  with  a  weak  solution  of  electrozone 
(about  a  teaspoonful  in  a  tumbler  of  water)  previous  to  the 
removal  of  the  cotton. 

Every  pledget  of  cotton,  previous  to  its  introduction,  should 
be  moistened  with  pure  electrozone,  and  packed  as  tight  in 
the  cavity  of  the  tooth  as  possible.  When  the  tooth  has 
been  treated  in  this  manner  for  two  or  three  days,  the  pulp- 
canal  may  be  cleaned  out  and  filled  at  once,  without  any  fear 
of  future  pericementitis,  provided  that  an  infection  of  perice- 
mentitis has  not  already  occurred. 

DENTAL  FORMULA. 

For  Cancrtim  Oris,  Aphthce  and  Gan-  For   Ulcerative  Stomatitis. 

grenons  Affections  of  the  Mouth.  g      Cupri  sulph gr.x 

R.    Cupri     sulph.     (pow-  Pulv.  cinchonae  .    .    .   gij 

dered) gr.v  Pulv.  gum  acacite  .    .   ^j 

Mellis gss.        M.  Mellis ^ij 

SiGNA. — Apply  as  a  lotion,  or  by  means  Aquse  .    ......   ^  iij.        M. 

of  a  camel's-hair  brush.  SiGNA. — Apply,  by  means  of  a  camel's- 

hair  brush,  to  the  ulcerated  surface. 


ESSENTIAL   OILS.  355 


For  Gangrenous   Ulcers  of  the  Mouth  For  Caries  of  the  Maxillary  Bones, 

and  Cancrum   Oris.  Bartholow. 

K.    Cupri  sulph ^ij  R  ^  Cupri  sulph., 

Pulv.  cinchonas  .    .    .   5  ss  Zinci  chloridi .    .    .  aa  partes  xv 

Aquse 5iv.        M.  Liquor  plumbi    .    .    .  partes  xxx 

SiGNA.— Brush   over  ulcerated  surface  Aquse  destillatae  .    .    .  partes  cc. 

twice  daily.  SiGNA. — To  be  applied  for  30  minutes 

at  a  time. 

ERGOTA— ERGOT. 

Derivation. — Ergot  is  a  fungous  growth  which  replaces  the 
grain  of  the  common  rye.  It  is  bitter,  and  excites  heat  and 
dryness,  followed  by  pain  in  stomach,  thirst,  vomiting  and 
intestinal  pain  and  sometimes  purging.  Small  doses,  long 
continued,  cause  spasms  and  death,  by  coma  and  asphyxia  ; 
gangrene  of  the  lower  extremities  may  follow  its  prolonged 
use. 

Medical  Properties  and  Action. — Ergot  causes  contraction 
of  the  involuntary  muscular  fibre,  the  uterus,  and  smaller 
blood  vessels,  and  dilates  the  pupils.  It  is  employed  to  pro- 
duce contraction  of  the  uterus  in  child-birth.  It  is  also  ad- 
ministered in  chronic  diarrhoea  and  dysentery,  enlarged  heart 
without  valvular  lesion,  gonorrhoea,  acne  rosacea,  etc.,  etc. 
It  is  very  serviceable  in  the  hemorrhagic  diathesis  where  there 
is  a  want  of  tonicity  of  the  vessels ;  also  used  in  epistaxis, 
uterine,  renal,  and  intestinal  hemorrhage,  and  in  haemoptysis, 
bleeding  of  hemorrhoids,  etc. 

Dose. — Of  the  fluid  extract  for  internal  use,  foss  to  ij  ;  of 
the  wine  of  ergot,  5j  to  ,5ss  ;  of  the  aqueous  extract  dissolved 
in  water  the  hypodermic  dose  is  gr.  ]/^  to  gr.  iij. 

Dental  Uses. — Ergot  is  useful  in  the  treatment  of  hemor- 
rhage of  the  gums,  and  that  following  the  extraction  of  teeth 
when  it  is  excessive  and  persistent. 

ESSENTIAL   OILS. 

The  volatile  or  essential  oils  are  compounds  of  carbon  and 
hydrogen,  and  differ  from  the  fixed  oils,  which  are  compounds 
of  carbon,  hydrogen  and  oxygen,  the  molecular  arrangements 


356  DENTAL  MEDICINE. 


of  which  are  similar  to  the  metallic  salts  and  compound  ethers 
— possessing  the  radicals  of  certain  acids  united  with  hydro- 
carbons. The  essential  oils  are  generally  absorbers  of  oxygen, 
and  such  of  them  as  the  oils  of  peppermint,  cloves,  caraway, 
cajeput,  mustard  and  turpentine  are  useful  obtunders  of  hyper- 
sensitive dentine;  and  some  are  also  efficient  germicides  and 
antiseptics.  From  experiments  noticed  by  Dr.  Harlan,  the 
essential  oils  are  not  miscible  with  water;  hence  when  they 
are  used  as  a  root-dressing  they  are  not  contaminated  or  dis- 
sipated by  the  saliva  or  the  mixed  fluids  of  the  mouth.  They 
are  capable  of  depositing  vaporizable  camphors  that  are  pow- 
erful disinfectants,  and  are  soluble  at  a  temperature  below  body 
heat.  They  are  good  menstrua  for  iodine  compounds,  and 
oily  dressings,  when  not  too  tightly  confined  in  a  pulp-chamber, 
are  not  vitiated  like  substances  which  are  soluble  in  water. 
They  may  be  allowed  to  remain  for  longer  periods  in  the  roots 
of  teeth,  when  it  is  not  possible  to  fill  such  roots  at  once. 
When  an  oily  dressing  (such  as  oil  of  peppermint  or  oil  of 
cassia)  is  applied  in  a  root  canal,  after  the  removal  of  a  pulp 
by  extirpation  or  its  devitalization  by  arsenic,  it  acts  as  an  ano- 
dyne and  also  as  an  antiseptic,  preventing  the  formation  of 
mephitic  gases.  The  oily  dressings  may  be  pumped  through 
roots  and  fistulous  tracts  with  impunity,  and  will  not  clog 
delicate  canals.  The  solutions  of  the  essential  oils  are  all 
made  as  follows  (Dr.  Black) :  "  An  excess  of  the  oil  is  mixed 
with  water  by  violent  shaking  continued  for  some  minutes.  It 
is  then  placed  in  the  incubating  oven,  where  the  temperature 
is  99°  F.,  for  twelve  hours.  It  is  then  again  violently  shaken 
and  returned  to  the  oven  for  another  twelve  hours,  twenty- 
four  hours  in  all.  It  is  then  carefully  filtered,  and  if  not  per- 
fectly clear  and  free  from  all  appearance  of  oil,  it  is  refiltered 
until  it  is  clear.  The  filtrate  is  then  used  as  the  solution  of 
the  oil.  The  same  plan  is  used  in  making  saturated  solutions 
of  the  crystalline  substances." 

The  prominent  essential  oils  are  those  of  cajeput,  cassia, 
cinnamon,  cloves,  eugenol,  eucalyptol,  fennel,  mustard,  cara- 
way,   peppermint,    sassafras,  turpentine,    thyme,    pennyroyal, 


ESSENTIAL  OILS.  357 


valerian,  wintergreen.  In  dental  practice  the  oil  of  cassia 
diluted  with  a  bland  oil  like  that  of  wintergreen  is  a  valuable 
dressing  for  putrid  root  canals  and  abscesses.  Dr.  Black 
recommends  the  following  mixture: 

I^.  Carbolic  acid  (melted  crystals),  i  part;  oil  of  cassia,  2 
parts;  oil  of  wintergreen,  3  parts.  Mix  the  oils  and  add  the 
melted  crystals  of  carbolic  acid.  This  is  known  as  the  i,  2, 
3  mixture. 

Dr.  Black  also  says :  "  After  thorough  cleaning  with  the 
watery  form  of  the  antiseptic  we  need  something  that  will  be 
more  enduring  in  its  effects,  and  according  to  conditions 
should  choose  between  the  oils  and  the  powders.  If  it  is  an 
abscess  with  which  we  have  to  deal,  an  oil  which  is  in  itself  an 
antiseptic,  or  an  oil  holding  the  antiseptic  drug  in  solution  in 
effective  proportions,  may  be  introduced  into  the  cavity  and 
so  agitated  as  best  to  bring  it  in  contact  with  all  of  its  parts. 
This  will,  on  account  of  its  sparing  solubility,  remain  in  posi- 
tion very  much  longer  than  the  watery  forms,  and  the  essen- 
tial oils  are  very  much  more  diffusible  than  the  fixed  oils,  or, 
indeed,  any  other  of  the  simple  forms  of  the  antiseptics  with 
which  I  am  yet  acquainted.  At  the  same  time  a  sufficient 
amount  for  very  extended  work  is  contained  in  small  compass. 
These  are  of  especial  value  in  such  positions  as  the  roots  of 
teeth.  In  this  position  any  but  the  most  irritating  of  the 
antiseptic  essential  oils  may  be  used  to  good  advantage,  and 
may  be  relied  upon  for  many  days  together.  In  the  choice  of 
the  essential  oils  it  is  by  no  means  necessary  that  the  most 
powerful  of  them  be  selected.  It  should  be  remembered  in 
making  the  choice  that  the  more  powerful  antiseptics  are  the 
more  irritating,  as  a  rule.  It  is  therefore  often  best  to  choose 
antiseptics  of  very  moderate  range,  especially  where  it  is  only 
required  to  preserve  a  condition  of  asepsis.  For  instance, 
when  a  very  foul  root  canal  is  opened,  such  an  antiseptic  as 
the  oil  of  cassia  is  indicated.  After  appropriate  cleaning,  and 
especially  in  case  cleaning  is  to  be  deferred  for  fear  of  forcing 
poisonous  material  through  the  apical  foramen,  it  may  be  used 
in  full  strength ;  in  which  form  it  may  be  relied  upon  as  a  dis- 


358  DENTAL   MEDICINE. 


infectant  as  well.  But  afterward,  when  it  is  only  a  matter  of 
holding  an  aseptic  condition  during  the  healing  of  the  parts, 
an  antiseptic  of  shorter  range,  that  is  not  so  liable  to  injure 
the  tissues,  is  to  be  preferred.  For  this  purpose  the  eucalypti 
extract  in  substance  is  a  very  useful  agent.  Its  range  of 
actual  inhibition  is  very  short,  but  its  injurious  effects  on  the 
tissues  are  also  very  slight,  so  that  the  healing  process  may 
go  on  in  its  presence  without  hindrance.  Furthermore,  this 
oil  has  a  very  extended  range  of  restraining  influence  beyond 
its  range  of  actual  inhibition  that  is  undoubtedly  of  much  use. 
This  oil  may  be  exchanged  for  terpinol  where  a  little  more 
stimulating  effect  is  regarded  as  beneficial.  The  oil  of  cloves 
and  the  oil  of  cinnamon  seem  to  occupy  a  middle  ground,  and 
may  be  made  useful  in  a  large  class  of  cases  if  the  others  are 
in  any  wise  distasteful  to  the  dentist  or  his  patient.  The  oil 
of  mustard,  though  a  good  antiseptic  of  short  range,  has  an 
irritant  action  that  limits  its  use.  Yet  in  cases  where  it  is  de- 
sirable to  arouse  the  tissues  from  a  state  of  inactivity  this 
action,  in  a  high  degree,  is  combined  with  the  antiseptic  prop- 
erty. It  is  also  one  of  the  most  diffusible  of  the  antiseptic 
oils  thus  far  studied. 

"  Any  of  these  oils  may  be  used  in  the  emulsion,  if,  for  any 
reason,  it  is  not  thought  well  to  use  the  oil  in  substance.  This 
form  is  especially  recommended  for  surfaces  of  suppurating 
wounds  and  the  washing  of  abscesses.  In  this  -way  small 
quantities  of  the  oil  may  be  widely  diffused  and  left  in  a  mul- 
titude of  minute  globules,  to  gradually  dissolve  where  it  is 
most  wanted,  forming  a  kind  of  connecting  link  between  the 
true  solutions  and  the  oils  in  substance.  For  this  purpose  a 
little  of  the  oil  selected  may  be  diffused  through  water  by 
severe  shaking,  or  better,  by  repeatedly  filling  and  violently 
emptying  the  syringe.  The  milky  emulsion  thus  formed  may 
be  used  in  the  same  manner  as  the  solution. 

"  I  have  said  that  all  antiseptics  are  poisons.  I  wish  to 
emphasize  this  statement.  They  are  antiseptic  by  virtue  of 
their  power  of  restraining  life  forces ;  and  their  use  as  anti- 
septics is  permitted  only  by  shades  of  difference  in  the  action 


BICHLORIDE   OF  ETHIDENE.  359 


of  certain  poisons  toward  the  different  forms  of  life,  by  which 
they  affect  the  fungi  more  prominently  than  the  animal  tis- 
sues." 

ETHIDENE  DICHLORIDUM— DICHLORIDE  OF  ETHIDENE. 

Formula. — CHgCHClj.     Sp.  gr.  1.225. 

Derivation. — Bichloride  of  Ethidene  is  obtained  in  the 
preparation  of  chloral,  from  the  waste  products,  and  is  very 
much  like  chloroform  in  appearance,  odor  and  taste.  It 
has  a  variable  boiling  point  of  about  115°  F.,  and  is  readily 
soluble  in  alcohol,  sparingly  soluble  in  water,  and  but  slightly 
soluble  in  chloroform.  It  is  inflammable,  but  less  so  than 
alcohol. 

Medical  Properties  and  Action. — Bichloride  of  ethidene  is  a 
general  anaesthetic,  and  is  said  to  occupy  an  intermediate  rank 
between  chloroform  and  ether.  It  reduces  the  action  of  the 
heart  to  a  less  degree  than  chloroform,  with,  however,  consid- 
erable depression  of  the  pulse. 

It  has  been  somewhat  employed  in  England,  where  it  is 
regarded  as  being  safer  than  chloroform  for  inhalation,  and 
requiring  less  quantity  to  produce  anaesthesia  than  ether. 

Methods  of  Administration. — It  is  recommended  to  admin- 
ister nitrous  oxide  until  the  patient  is  nearly  unconscious,  and 
then  to  add  the  vapor  of  ethidene.  The  effects  of  this  agent 
are  described  as  follows  :  The  pupils  dilate,  and  at  the  same 
time  stertorous  breathing  commences;  the  pulse  falls,  and 
should  be  carefully  watched,  and  insensibility  to  pain  con- 
tinues for  some  time  after  the  patient  becomes  conscious.  It 
is  also  claimed  for  this  agent  that  there  are  no  unpleasant 
after-effects,  the  patient  recovering  as  if  from  a  natural  sleep, 
with  a  clear  mind  and  a  distinct  utterance.  It  is  also  recom- 
mended to  combine  the  vapor  of  ethidene  with  that  of  nitrous 
oxide,  by  loosely  inserting  a  sponge  containing  half  an  ounce 
of  ethidene  in  the  nitrous  oxide  gas-inhaling  tube,  or  in  the 
rubber  supply-bag,  when  the  effect  is  said  to  be  more  profound 
and  agreeable  than  when  nitrous  oxide  alone  is  administered, 
with  no  nausea  and  but  little  lividity  of  the  lips.     It  is  also 


360  DENTAL  MEDICINE. 


said  to  produce  relaxation  of  the  muscles  rather  than  rigidity, 
differing  in  this  respect  from  nitrous  oxide  gas. 

Dichloride  of  ethidene  is  also  employed  as  a  local  anaes- 
thetic, in  the  same  manner  as  chloroform,  aconite,  etc.,  for  the 
relief  of  facial  neuralgia,  etc. 

It  has  not  been  introduced  to  any  extent  into  this  country. 

ETHYL  CHLORIDE— (MONO-CHLOR-ETHANE). 

Formula. — CgHgCl . 

Derivation. — Ethyl  chloride  is  best  prepared  by  saturating 
an  artificially  cooled  alcoholic  solution  of  zinc  chloride  with 
hydrochloric  acid  gas  ;  it  may  also  be  obtained  as  a  by-product 
in  the  manufacture  of  chloral.  It  belongs  to  the  ether  class, 
and  at  ordinary  temperature  is  a  gas;  but  it  is  easily  com- 
pressed, and  then  forms  a  colorless  liquid  possessing  an  agree- 
able, but  not  very  strong  ethereal  odor,  boiling  between  50° 
and  53.6°  Y.,  and  burning  with  a  green  flame.  It  is  sold  in  the 
compressed  state  in  hermetically  sealed  glass  tubes,  elongated 
to  a  capillary  point,  which  serves  not  merely  as  a  vehicle  for 
containing  it,  but  also  as  the  apparatus  for  applying  it,  for 
owing  to  its  low  boiling  point  it  is  admirably  adapted  in  this 
form  to  the  rapid  production  of  anaesthesia.  The  best  manner 
suggested  for  breaking  the  flask  or  tube  is  to  hold  it  vertically, 
attenuated  end  up  ;  grasp  the  pointed  end  with  a  pair  of  plyers 
and  fracture  at  the  file  mark  which  is  made  nearer  or  at  the  end 
of  the  capillary  elongation,  so  that  the  escaping  stream  of  vapor 
shall  be  attenuated  to  the  greatest  degree  possible,  and  then 
directed  upon  the  surface  to  be  anaesthetized. 

Mode  of  Application. — The  distance  at  which  the  glass  tube 
should  be  held  from  the  part  to  be  anaesthetized  varies  consid- 
erably, for  it  may  be  two,  six,  eight,  ten,  or  even  twenty  inches, 
depending  somewhat  upon  the  size  of  the  aperture  in  the 
elongated  end  of  the  tube;  it  is  necessary  that  the  stream  of 
vapor  should  reach  the  tissue  exactly  at  the  time  of  perfect 
volatilization.  After  the  attenuated  end  of  the  tube  is  broken 
off  at  the  file  mark  the  tube  is  then  everted,  and  the  heat  of  the 
hand  grasping  it  will  accelerate  the  escape  of  the  stream  of 


ETHYL   CHLORIDE.  361 


vapor,  which  may  be  arrested  by  returning  the  tube  to  the 
position  in  which  it  was  held  when  broken,  and  placing  a 
finger  over  the  aperture.  Each  flask  or  tube  contains  ten 
grammes  of  pure  chloride  of  ethyl,  which  is  considered  to  be 
sufficient  for  the  extraction  of  about  four  teeth.  When  only 
a  portion  of  the  contents  of  the  tube  has  been  used  the 
remainder  can  be  preserved  by  forcing  the  broken  end  into  a 
rubber  stopper  and  setting  it  in  a  cool  place  ;  or  a  little  adhe- 
sive wax  may  be  forced  into  the  aperture,  but  not  melted  and 
dropped  on. 

Therapeutic  Uses  and  Action. — Ethyl  chloride  is  employed 
in  minor  and  dental  surgery  as  a  local  anaesthetic,  and  its  appli- 
cation does  not  occasion  any  untoward  accessory  symptoms, 
and  it  has  no  influence  on  the  brain,  having  in  this  respect  a 
great  advantage  over  methyl  chloride  whose  application  is 
followed  by  a  weakness  of  memory  usually  lasting  for  more 
than  twelve  hours ;  ethyl  chloride  does  not  produce  the  extra- 
ordinary cold  which  may  cause  destruction  of  tissue  as  does 
methyl  chloride.  Chloride  of  ethyl  will  produce  general  anaes- 
thesia if  inhaled,  and  it  is  therefore  necessary  when  applying 
it  within  the  mouth  to  have  the  patient  breathe  only  through 
the  nose,  as  there  is  no  evidence  of  its  safety  as  a  general 
anaesthetic.  Properly  applied,  and  not  too  long  continued, 
there  is  no  danger  of  freezing  the  part  to  the  stage  of  devitali- 
zation with  consequent  sloughing.  On  account  of  its  great 
inflammability  it  must  be  used  at  a  safe  distance  from  a  flame 
— preferably  under  electric  light  when  applying  it  at  night. 
As  it  is  extremely  volatile  it  should  be  kept  in  a  cool  place ; 
and  this  extreme  volatility  is  a  proof  that  its  effect  upon  the 
human  system  is  of  correspondingly  brief  duration,  as  it  acts 
not  by  virtue  of  any  inherent  anaesthetic  properties,  but  on 
account  of  the  intense  cold  produced  by  its  extraordinary 
rapid  volatilization.  Its  depressing  effect  upon  the  circulation 
when  administered  is  too  pronounced  for  it  to  be  regarded  as 
a  safe  general  anaesthetic.  As  a  local  anaesthetic,  however,  it  has 
practically  no  effect  upon  the  human  system,  and  any  of  the 
drug  that   is  absorbed  into  the  system  is  eliminated  in  the 


362  DENTAL   MEDICINE. 


course  of  a  few  minutes.  It  has  given  satisfactory  anaesthesia 
in  operations  for  cellulitis  of  fingers,  buboes,  abscesses,  sinuses, 
boils,  carbuncles,  in-growing  nails,  etc.,  all  forms  of  neuralgic 
pain,  rheumatic  pain,  hyperaesthenic  and  reflex  conditions. 

Dental  Uses. — Chloride  of  ethyl  is  employed  in  dental  prac- 
tice as  a  local  anaesthetic  for  the  extraction  of  teeth,  and  has 
proven  very  satisfactory  in  such  operations.  The  adjoining 
teeth  should  be  protected  by  a  fold  of  napkin,  the  gum  dried 
about  the  tooth  to  be  extracted,  and  then  coated  with  glyce- 
rine, and  the  vapor  directed  on  the  gum  and  not  upon  the  tooth 
until  the  former  turns  white,  when  the  forceps  are  applied.  It 
is  also  used  for  obtunding  the  pulp  prior  to  extirpating  it,  and 
also  for  obtunding  sensitive  dentine,  for  which  purposes  the 
rubber  dam  should  be  adjusted  large  enough  to  cover  the  nose, 
and  the  cavity  dried,  as  the  drug  has  little  or  no  affinity  for 
water,  and  the  vapor  thoroughly  introduced  to  the  sensitive 
surface  of  the  dentine  or  to  the  exposed  surface  of  the  pulp, 
when  the  excavation  or  removal  can  be  painlessly  performed. 
Dr.  L.  E.  Custer  recommends  grinding  off  the  point  of  the 
tube  with  a  corundum  or  carborundum  disk  about  one-fourth 
of  an  inch  further  towards  the  end,  in  order  that  the  jet  of  vapor 
may  be  so  attenuated  by  escaping  from  a  smaller  orifice  that 
it  will  not  flood  the  cavity  before  it  volatilizes  fast  enough. 
Chloride  of  ethyl  is  also  employed  for  the  relief  of  neuralgia 
by  directing  the  vapor  along  the  track  of  the  affected  nerve ; 
also  for  diagnosing  peripheral  from  centric  neuralgias  by  apply- 
ing the  vapor  at  the  point  of  irritation — if  the  neuralgia  results 
from  peripheral  irritation  the  pain  will  cease  at  once;  and  inter- 
mittent applications,  continued  for  from  twenty  to  thirty  minutes, 
are  often  curative  when  the  irritation  is  not  due  to  exposure  of 
the  pulp.  Chloride  of  ethyl  may  also  be  employed  for  opening 
alveolar  abscesses,  removing  tumors  of  the  mouth,  and  in  other 
painful  affections  of  the  oral  cavity.  Prof.  C.  Redard  suggests 
that  in  the  extraction  of  teeth  in  the  lower  jaw  the  vapor  or 
stream  be  directed  externally  against  the  cheek,  over  the  infe- 
rior maxillary  nerve ;  while  in  the  extraction  of  teeth  from  the 
upper  jaw  it  be  directed  in  front  of  the  ear  at  the  exit  of  the 


BROMIDE   OF  ETHYL.  363 

trigerminal  nerve.  When  applied  to  a  part  chloride  of  ethyl 
first  causes  a  hyperaemia,  then  pallor,  and  gradually  the  part 
assumes  a  parchment-like  appearance.  From  one  to  two 
minutes  is  generally  required,  and  the  anaesthesia  lasts  as  long 
again.  It  has  been  suggested  to  occasionally  combine  the 
action  of  chloride  of  ethyl  with  that  of  cocaine. 

ETHYL  BROMIDUM— BROMIDE  OF  ETHYL. 
HYDROBROMIC  ETHER. 

Formula. — CgHgBr.     Sp.  gr.  1.420. 

Derivation. — Bromide  of  Ethyl  is  obtained  from  bromide 
of  potassium,  sulphuric  acid,  alcohol  and  water,  by  distilla- 
tion, and  is  re-distilled  by  chloride  of  calcium.  It  is  a  color- 
less and  very  volatile  liquid,  boiling  at  40°  C,  heavier  than 
water,  and  possesses  an  agreeable  ethereal  odor,  and  a 
pungent  taste,  strong  and  sweetish,  with  a  somewhat  burning 
after-taste.  It  is  readily  soluble  in  alcohol  and  ether,  and  but 
sparingly  soluble  in  water. 

Medical  Properties  and  Action. — Bromide  of  ethyl  is  con- 
sidered to  be  a  very  effective  and  pleasant  general  anaesthetic, 
but,  like  all  other  agents  of  this  class,  it  must  be  administered 
with  great  care,  and  a  pure  article  employed.  There  is  no 
doubt  but  that  it  is  pleasanter  to  inhale  than  chloroform,  ex- 
ceedingly rapid  in  producing  complete  unconsciousness,  and 
very  evanescent  in  its  action.  That  it  is  any  safer  than  some 
other  and  older  agents  of  this  class,  clinical  experience  has 
not  demonstrated,  as  several  deaths  occurred  in  a  very  limited 
number  of  the  administrations  attending  its  introduction. 
Bromide  of  ethyl  is  not  inflammable,  nor  caustic,  nor  even 
irritant,  in  this  respect  being  preferable  to  chloroform,  which 
is  very  caustic,  and  to  sulphuric  ether,  of  which  the  ingestion 
is  nearly  impossible.  Dr.  Isaac  Ott,  comparing  bromide  of 
ethyl  with  other  anaesthetics,  says  :  "  [a)  Chloroform  increases 
the  pulse,  then  slows  it  by  a  cardiac  inhibitory  stimulation  ; 
ether  increases  the  pulse ;  nitrous  oxide  also  increases  it  by 
paralysis  of  cardiac  inhibitory  apparatus  ;  whilst  bromide  of 
ethyl  increases  the  pulse  by  an  action  on  the  heart  itself.     (/;) 


364  DENTAL   MEDICINE 


Chloroform  reduces  the  blood  pressure  by  paralysis  of  the 
main  vaso-motor  centre,  and  cardiac  debility ;  ether  greatly 
increases  it  and  keeps  it  increased  ;  and  nitrous  oxide  also 
increases  it ;  bromide  of  ethyl  increases  it  either  by  a  stimula- 
tion of  the  spinal  or  peripheral  vaso-motor  system,  (c)  Chlo- 
roform increases,  and  then  decreases,  respiration ;  nitrous 
oxide  reduces  it ;  bromide  of  ethyl  decreases  it  by  central 
action."  He  also  draws  the  following  conclusions  :  "  i.  Bro- 
mide of  ethyl,  either  by  inhalation  or  subcutaneous  uses,  kills, 
by  a  toxic  action  on  the  centres  of  respiration.  2.  That  the 
decrease  of  force  and  frequency  of  the  heart  contributes  to 
the  paralysis  of  the  respiratory  centres.  3.  That  injections  of 
ethyl  into  the  jugular,  towards  the  heart,  kill,  by  cardiac 
arrest,  probably  due  to  an  action  on  the  cardiac  muscle.  4. 
Bromide  of  ethyl,  in  toxic  doses,  depresses  momentarily  the 
frequency  of  the  heart,  which  is  followed  by  a  subsequent  rise 
to  a  normal  rate.  5.  Bromide  of  ethyl,  in  toxic  doses,  de- 
presses the  arterial  tension,  due,  in  major  part,  to  the  depres- 
sant action  of  the  drug  upon  the  heart,  and  in  a  minor  part, 
to  a  partial  loss  of  tone  of  either  the  spinal  vaso-motor  cen- 
tres or  the  peripheral  vaso-motor  system.  6.  The  inhibitory 
power  of  the  pneumogastric  is  not  paralyzed." 

Introduced  into  the  stomach,  bromide  of  ethyl  does  not 
produce  anaesthesia,  as  when  absorbed  by  the  respiratory 
organs,  and  does  not  increase  the  pulse  over  its  normal  heat ; 
and  in  the  second  stage,  causes  an  intermission  of  the  pulse 
every  second  beat. 

Administration. — Bromide  of  ethyl  is  best  administered  in  a 
folded  starched  napkin,  so  as  to  cover  the  face,  and  having 
inside  of  it  a  soft  linen  handkerchief.  On  the  linen  handker- 
chief one  measured  drachm  of  the  agent  should  be  poured, 
and  the  patient  directed  to  take  long,  deep  inspirations,  or, 
what  is  better,  to  make  prolonged  and  forced  expirations.  In 
two  minutes  from  the  time  of  administration  of  the  first 
drachm,  a  second  should  be  given,  and  this  should  be  re- 
peated at  intervals  of  two  minutes.  Like  all  general  anaes- 
thetics, however,  the  quantity  for  inhalation  differs  according 


BROMIDE   OF   ETHYL.  365 

to  the  susceptibility  of  the  patient.  One  drachm  (or  in  some 
cases  two  drachms  may  be  required,  according  to  the  suscep- 
tibility of  the  patient)  of  the  bromide  of  ethyl  will  generally, 
in  from  one  to  three  minutes,  produce  an  anaesthesia  as  pro- 
found as  that  produced  by  an  ounce  of  sulphuric  ether.  As 
it  produces  an  anaesthetic  effect  on  the  muscles  of  the  throat 
and  upper  parts  of  the  pharynx,  it  is  useful  for  operations  on 
the  mouth  and  throat. 

The  effect  of  an  anaesthetic,  however,  is  to  be  more  regarded 
than  the  mere  quantity  of  the  agent  poured  upon  a  napkin  or 
sponge,  as  the  degree  of  anaesthesia  should  be  governed,  in 
most  cases,  by  the  nature  of  the  operation  to  be  performed 
under  its  influence. 

Prof  Chisholm  says :  "  I  have  found  the  action  of  bromide 
of  ethyl  so  very  evanescent  that  it  can  never  take  the  place  of 
either  chloroform  or  of  sulphuric  ether  for  any  surgical  opera- 
tion which  requires  some  time  for  its  performance ;  but  for  all 
quick  work,  which  can  be  done  in  one  or  two  minutes,  the  use 
of  this  anaesthetic  agent  leaves  nothing  to  be  desired.  These 
really  magical  effects  must  be  obtained  from  the  first  inhala- 
tion, what  I  call  the  primary  anaesthesia.  If  the  operation  be 
protracted,  and  a  second  or  even  third  dose  of  the  bromide  of 
ethyl  be  inhaled,  and  I  find  nausea,  vomiting  and  heaviness  in 
all  respects  as  if  chloroform  or  ether  had  been  used — under 
this  repetition,  bromide  of  ethyl  loses  all  its  advantages." 

The  odor  of  bromide  of  ethyl  is  more  rapidly  removed,  and 
is  more  agreeable  than  that  of  sulphuric  ether,  and  its  effects 
more  rapid  than  even  those  of  chloroform,  as  it  is  eliminated 
by  respiration,  and  by  the  kidneys,  more  speedily  than  any 
other  general  anaesthetic  agent.  It  requires  excessive  quanti- 
ties to  affect  the  heart  and  respiration  to  any  great  degree. 
Having  no  caustic  action,  it  can  be  safely  applied  subcuta- 
neously,  and  also  to  the  external  auditory  meatus  and  to  the 
mucous  membrane.  It  evaporates  upon  the  skin  very  rapidly, 
producing  a  very  sensible  feeling  of  cold.  As  a  rule,  its  general 
effects  are  as  follows :  Moderate  acceleration  of  the  pulse  and 
respiration;    slight    excitement  or  talking,  and    seldom   any 


366  DENTAL  MEDICINE. 


struggling;  flushing  of  face;  dilatation,  sometimes  preceded 
by  contraction  of  pupil;  diaphoresis,  generally  profuse;  com- 
plete anaesthesia  in  two  or  three  minutes;  recovery  of  con- 
sciousness in  from  one  to  two  minutes  after  the  withdrawal  of 
the  anaesthetic  agent ;  no  after-vomiting. 

Any  specimen  of  bromide  of  ethyl  which  has  a  disagreeable 
odor,  or  which,  on  standing,  becomes  brown,  or  any  that  will 
explode  and  burn,  is  impure  and  should  not  be  employed  for 
inhalation.  A  common  impurity  is  bromoform,  produced  by 
the  action  of  bromine  and  caustic  potassa  on  alcohol  or  wood 
spirit.  Bromide  of  ethyl  possesses  properties  intermediate 
between  those  of  chloroform  and  ether.  As  a  local  anaes- 
thetic it  is  highly  spoken  of,  and,  owing  to  its  non-inflamma- 
bility, is  the  only  anaesthetic  which  can  be  used  in  connection 
with  the  actual  cautery.  Dr.  Byrd  strongly  recommends  an 
anaesthetic  mixture  of  bromide  of  ethyl  i  part,  chloroform  3 
parts  and  alcohol  4  parts,  a  drachm  of  which  is  poured  upon 
the  sponge  of  the  inhaler,  which  the  patient  is  allowed  to 
inhale  with  the  stopper  out,  after  which  the  stopper  is  re- 
placed and  the  full  strength  of  the  mixture  inhaled.  Gen- 
erally in  five  minutes  the  patient  is  fully  anaesthetized,  when 
the  stopper  may  be  taken  out  to  permit  a  greater  admixture 
of  air,  and  replaced  as  the  judgment  of  the  operator  may  dic- 
tate. This  mixture,  it  is  claimed,  is  safer  and  less  disagreeable 
in  its  effects  than  the  bromide  alone.  For  use  as  a  local 
anaesthetic,  the  bromide  of  ethyl  is  atomized  with  the  "  spray 
apparatus,"  which  should  furnish  enough  of  the  liquid  to 
moisten  the  skin.  The  extremity  of  the  tube  should  be  held 
some  two  or  three  inches  from  the  surface  on  which  the  spray 
is  to  be  thrown.  Within  two  or  three  minutes  after  its  first 
application,  anaesthesia  of  the  part  occurs,  which  is  shown  by 
the  appearance  of  a  white  spot.  The  formation  of  this  spot 
may  be  hastened  by  superficially  puncturing  or  scratching  the 
skin.  The  sensation  of  cold  thus  produced  is  sometimes  dis- 
agreeable, but  is  rarely  painful.  The  skin,  or  even  the  thin 
layer  of  the  subjacent  tissue,  may  be  painlessly  incised  while 
the  white  spot  lasts.     This  anaesthetic  appears  to  be  very  well 


EUCALYPTUS.  367 


adapted  for  short  operations,  requiring  simple  anaesthesia  and 
not  complete  resolution;  hence  it  is  now  preferred  by  some, 
for  the  extraction  of  teeth,  to  either  chloroform  or  ether. 
Internally,  bromide  of  ethyl  has  lately  been  recommended  for 
whooping  cough,  in  the  form  of  a  solution  of  i  part  of  bromide 
of  ethyl  in  200  parts  of  water;  also  in  angina  pectoris,  the 
dose  being  one-half  to  two  ounces. 

Given  internally,  it  is  also  said  to  relieve  gastric  pain  with- 
out affecting  the  appetite.  Inhalations  readily  relieve  con- 
vulsive cough  ;  and,  introduced  on  cotton  wool  into  the  ex- 
ternal meatus,  it  relieves  the  pain  of  otalgia,  without  causing 
any  irritation. 

Poiton  Duplessy  recommends  the  combined  use  of  bromide 

of  ethyl  and  chloroform  for  prompt  and  effective  production  ot 

anaesthesia,  and  he  also  asserts  that  the  toxic  effects  are  reduced 

to  a  minimum. 

EUCALYPTUS. 

Source. — Eucalyptus  is  obtained  from  the  eucalyptus  globu- 
lus, a  tree  of  large  size,  and  of  the  natural  order  Myrtaceae, 
found  originally  in  Australia,  and  known  as  the  "  Blue  Gum 
Tree."  These  trees  are  nowgrowing  in  the  southern  parts 
of  Europe  and  the  United  States,  and  northern  Africa,  and 
their  presence  is  thought  to  be  preventive  of  malaria.  The 
leaves,  which  are  ensiform,  of  a  grayish-green  color,  and 
parchment-like,  are  the  only  part  which  possesses  medicinal 
qualities.  They  have  a  pleasant,  aromatic  odor,  with  a  warm, 
bittef  and  somewhat  pungent  taste,  like  that  of  cubebs,  the 
fresh  being  more  active  than  the  dried  leaves.  Their  medi- 
cinal virtue  is  owing  to  a  volatile  oil — Oleum  Eucalypti — 
which  contains  three  principles,  called  eucalyptene,  turpene, 
and  cymol.  Tannic  acid,  and  a  peculiar  crystalline  fatty  acid, 
are  also  found  in  eucalyptus  ;  but  eucalyptene  is  the  most  im- 
portant constituent. 

Medical  Properties  and  Actio?i. — Eucalyptus  is  antiseptic, 
disinfectant,  sedative,  tonic,  diaphoretic  and  somewhat  astrin- 
gent. When  taken  into  the  mouth,  it  excites  a  flow  of  saliva, 
and  leaves  a  hot,  pungent  taste,  and  a  persistent  and  disagree- 


368  DENTAL   MEDICINE. 


able  odor.  When  introduced  into  the  stomach,  it  causes  a  sen- 
sation of  warmth,  and  promotes  the  secretion  of  the  gastric 
juice.  Being  stomachic,  it  increases  the  appetite  and  the  diges- 
tive action,  with  increased  intestinal  secretion.  Large  doses 
produce  offensive  eructations,  a  feeling  of  weight  and  tension 
at  the  epigastrium,  and  indigestion,  followed  by  diarrhoea,  and 
irritation  and  congestion  of  the  kidneys.  It  increases  the  ac- 
tion of  the  heart,  lessening  the  arterial  tension,  and  causes  a 
feverish  condition.  It  accelerates  the  respiratory  movements, 
and  although  it  induces  sleep  in  the  weak  and  anaemic,  it  has 
the  opposite  effect  on  the  strong  and  healthy.  The  secretions 
of  the  skin,  mucous  membrane  and  kidneys  are  increased  by 
it,  and  become  strongly  odorous,  owing  to  the  presence  of 
eucalyptol,  a  name  given  to  the  oil.  The  inhalation  of  large 
quantities  of  the  vapor  produces  effects  analogous  to  those  of 
the  agent  when  taken  in  substance,  and  the  essential  oil  is 
readily  diffusible  and  readily  impregnates  the  blood. 

Therapeutic  Uses. — While  the  internal  use  of  eucalyptus  is 
contra-indicated  in  inflammatory  conditions,  it  is  a  very  effi- 
cient remedy  in  atonic  dyspepsia;  chronic,  gastric  and  intes- 
tinal catarrh,  cachectic  conditions,  flatulence,  palpitation  of  the 
heart,  hysteria,  chorea,  asthma,  catarrhal  broncho-pulmonary 
affections,  chronic  diseases  of  the  liver  and  bladder,  etc.  It  is 
also  employed  in  intermittent  fever,  and  during  convalescence 
from  remittent  fever.  Externally,  it  is  an  efficient  application 
to  chronic  forms  of  angina  and  tonsillitis,  to  foul  ulcers  and 
wounds,  etc. 

Dose. — Of  the  fluid  extract  of  eucalyptus,  5ss-5j ;  of  the 
tincture  of  eucalyptus — Ttnctura  Eucalypti — foss  to  foij ;  of 
the  extract — Extractuni  Eucalypti, — gr.  j  to  3j ;  of  eucalyptol, 
the  dose  is  TTtv  to  5ss,  in  capsules  or  emulsion. 

Dental  Uses. — In  dental  practice,  the  decoction  of  the  leaves 
is  an  efficient  local  application  in  the  different  forms  of  stoma- 
titis, after  the  acute  stage  has  subsided.  The  tincture  and  the 
distilled  water  of  eucalyptus,  or  fluid  extract,  are  used  as  dis- 
infectant applications  in  indolent  offensive  ulcers  of  the  mu- 
cous membrane  of  the  mouth,  stomatitis,  pharyngitis,  etc.  The 


EUCALYPTUS.  369 


tincture  of  eucalyptus  has  been  employed  with  advantage  to 
obtund  the  sensibility  of  dentine.  The  oil  of  eucalyptus, 
either  alone  or  combined  with  iodoform,  forms  one  of  the  most 
effective  antiseptics  in  use,  for  the  treatment  of  putrescent 
pulps  of  teeth,  alveolar  abscess,  of  the  chronic  form,  pyorrhoea 
alveolaris,  foul  ulcers  of  the  mouth,  etc. 

No  other  preparation  appears  to  prove  more  efficient  as  an 
antiseptic  than  the  combination  of  eucalyptus  oil  and  iodo- 
form, in  the  treatment  of  suppurating  conditions,  putrescent 
pulp-canals,  necrosis,  and  caries  of  the  bones  of  the  jaws,  etc. 
The  oil  can  be  introduced  as  an  injection,  with  an  abscess 
syringe,  or  by  means  of  a  fine  broach  armed  with  cotton,  tak- 
ing care  that  the  agent  is  carried  to  the  seat  of  the  disease, 
and  the  application  repeated  as  often  as  necessary.  It  may 
also  be  applied  by  dipping  a  pledget  of  cotton  in  the  oil  and 
then  in  finely  pulverized  iodoform  (Truman),  and  carried  to 
the  tooth,  as  in  cases  of  putrescent  pulps.  It  is  also  employed 
as  a  local  anaesthetic  for  odontalgia,  and  as  an  astringent  or 
styptic  in  superficial  hemorrhages,  mucous  discharges,  ulcer- 
ating mucous  membrane  of  the  mouth,  and  for  spongy, 
ulcerating  gums. 

Eucalyptus  has  a  solvent  effect  upon  gutta-percha,  a  fact 
which  should  be  remembered  when  using  it  in  connection  with 
temporary  fillings  of  the  former  material,  or  of  Hill's  stopping. 

DENTAL   FORMULAE. 
For  Abscess  of  Antrum.  For  Root  Canals  as  an  Antiseptic. 

R.    Olei  eucalypti    .    .    .  gij  R.   D.  Pedley. 

Acidi  carbolic!    .    .    .  gtt.x 

^1         .   .                          _ ..  R.    Olei  eucalypti .    .    .  2  parts 

Glycenni Zij  ^^  ^ 

rM  •         ui,     •                  -  -Kit                 Olei  caryoph.  .    ,    .  i.  parts 

Olei  gaultheriEe  .    .    .  gss.  M.                             ^   ^  -^  '^ 

e ,.       TT                •  •     i-  Creasoti  .        ...  lo  parts.      M. 

SiGNA. — Use  as  an  injection.  .        .  ^ 

Into   this   dissolve   gum   mastich    to 

For  Suppurating  Pulps,  Ulcers,  etc.  saturation,   filter    through   cotton- wool 

U.    Olei  eucalypti    .    .    .  3J  and  thoroughly  incorpoi ate  with  iodo- 

lodoformi gr-xv.     M.  form  in   a  mortar  until  it   becomes  a 

SiGNA. — Apply    as     an    injection,    by  solid  mass. 

means  of  a   syringe ;    or   on  cotton  Signa.  —  Introduce     on    floss-silk    or 

wrapped  on  the  end  of  a  fine  broach  ;  wisps  of  cotton,  and  cap  it  with  a  disk 

or  on  a  strand  of  floss-silk.  of  metal  and  insert  temporary  filling. 

24 


370  DENTAL  MEDICINE. 


For  Abscess  of  Antrum.  For  Alveolar  Pyorrhoea. 

Geo.  L.  Parmele.  ,  r,-     ,    ^.         s 

yKiggs    Disease.) 

^-   f'J^f  P^! 5J  G.  V.  Black. 

lodoiormi gr.x 

Aquse ^j.  M.  R  •    Olei  eucalypti    .    .    .  TTtxc 

SiGNA. — To  be  used  as  an  injection  in  Acidi  carbolici    .    .    .  TlXxc 

connection  with  a  tent    of  floss-silk  Olei  gaultherise  .    ,    .  ttixxx.   M. 

saturated   with    glycerine  and  euca-  Signa. — Apply  by  means  of  an  abscess 

lyptus.  syringe. 

EUGENOL— ACETAMID. 

Eugenol-acetamid  is  prepared  as  follows :  Monochloracetic 
acid  is  acted  upon  by  eugenol  sodium,  when  eugenol  acetic 
acid  results.  This  .acid  is  treated  with  alcohol  and  hydro- 
chloric acid,  by  which  it  is  converted  into  the  "  ethylester  of 
eugenol-acetic  acid.  Strong  alcoholic  ammonia  converts  this 
into  eugenol-acetamid.  As  crystallized  from  water  it  occurs 
in  lustrous  scales;  from  alcohol  in  fine  needles;  melting  at 
IIO°." 

Therapeutic  and  Dental  Uses. — It  is  claimed  for  eugenol- 
acetamid,  that  when  it  is  applied  in  the  form  of  a  fine  powder, 
it  produces  local  anaesthesia  without  any  caustic  action,  similar 
to  cocaine.  It  has  been  successfully  employed  as  a  local 
anaesthetic  in  the  treatment  of  wounds ;  and  is  also  recom- 
mended as  an  obtundent  in  the  extraction  of  teeth. 

EUROPHEN— ISOBUTYL-ORTHO-CRESOL-IODIDE. 

Derivation. — Europhen  is  obtained  by  the  action  of  isobutyl- 
alcohol  upon  <?-cresol  in  the  presence  of  chloride  of  zinc  at  an 
elevated  temperature,  producing  isobutylcresol.  This  is  then 
acted  upon  by  iodine  in  potassium  iodide,  the  resulting 
iodine  compound  being  isobutylorthocresoliodide  or  europhen. 
Europhen  is  an  amorphous  yellow  precipitate,  which  is  sepa- 
rated by  filtration  and  cleansed  by  washing,  and  afterward 
dried  in  the  dark  at  ordinary  temperature. 

The  percentage  of  iodine  in  europhen  is  about  27.6,  which 
corresponds  accurately  with  a  proportion  of  one  atom  of  iodine 
to  two  molecules  of  isobutylcresol.     Europhen  is  resinous  to 


EUROPHEN.  371 


the  touch,  and  when  applied  to  the  mucous  membrane  or  to 
the  skin,  adheres  tenaciously.  It  possesses  an  aromatic  odor, 
which,  however,  disappears  when  it  is  made  into  a  solution  or 
mixture.  It  is  insoluble  in  glycerine  or  water,  but  readily 
soluble  in  alcohol  (30  per  cent.),  ether  or  chloroform  (equal 
weight),  and  such  compounds  of  these  agents  as  collodion, 
and  liquid  gutta-percha,  and  also  in  fatty  oils.  A  25  per  cent. 
solution  of  europhen  can  be  made  by  rubbing  it  at  a  low  tem- 
perature in  olive  oil,  which,  after  being  filtered,  remains  clear 
for  a  long  period.  In  contact  with  wound  secretions,  it  gives 
off  slowly  small  quantities  of  iodine,  which  are  immediately 
combined  again,  and  form  the  soluble  compound.  The  chief 
action  of  europhen  can  be  ascribed  to  this  formation  in  the 
nascent  state ;  hence  there  is  present  in  this  agent  very  small 
quantities  of  free  iodine,  which  form  during  the  drying  process 
and  cannot  be  removed  from  it, — the  percentage  has  been 
estimated  at  about  0.03  per  cent. 

On  account  of  europhen  being  easily  decomposed,  all  starch 
mixed  with  it  and  also  mixtures  of  metallic  oxides,  are  contra- 
indicated.  Talcum  is  employed  to  make  with  it  a  thick  paste, 
and  simple  mixtures  of  it  with  fats,  vaseline  or  lanoline  are 
very  durable,  especially  the  latter.  Europhen  solutions  must 
be  prepared  at  a  low  temperature,  and  it  must  be  protected 
from  the  light  and  moisture. 

Therapeutic  Action. — Europhen  is  employed  as  a  substitute 
for  iodoform  in  the  treatment  of  wounds,  as,  it  is  claimed,  that 
a  given  weight  of  europhen  will  cover  five  times  as  large  a 
wound  surface  as  the  same  weight  of  iodoform ;  and  also  that 
it  will  prove  efficacious  in  cases  where  iodoform  fails. 

Its  freedom  from  odor  and  non-toxic  effects  are  also  advan- 
tages over  iodoform. 

Denial  Uses. — Europhen  is  employed  in  dental  practice  for 
irritation  and  inflammations  of  the  oral  mucous  membrane, 
such  as  may  result  from  artificial  dentures,  crown-  and  bridge- 
work,  as  it  acts  promptly  and  efficiently  in  reducing  the  swell- 
ing and  soreness ;  also  in  Syphilitic  mucous  patches  on  the 
cheeks  and  tongue;  it  is  also  employed  to  relieve  the  pain  of 


372  DENTAL  MEDICINE. 


inflamed  or  suppurating  pulps  of  teeth  on  account  of  its  rapid 
action.  Dr.  A.  W.  Harlan  recommends  for  such  purposes, 
powdered  europhen  rubbed  up  with  lanolin  (25  parts  of 
europhen  to  75  parts  of  lanolin).  He  has  also  found  such  a 
combination  to  be  of  service  in  the  after-dressing  of  the 
pockets  of  alveolar  pyorrhoea,  and  as  a  parasiticide,  and  as  a 
dressing  in  empyema  of  the  antrum. 

The  powdered  europhen  is  also  applied  in  gingival  inflamma- 
tions resulting  from  setting  crowns  and  bridges,  with  great  suc- 
cess ;  also  to  an  inflamed  and  suppurating  pulp. 

FERRUM— IRON. 

Chemical  analysis  -demonstrates  the  presence  of  iron  in  the 
blood,  the  gastric  juice,  chyle,  lymph,  bile,  milk,  urine  and 
the  pigment  of  the  eye ;  and,  although  metallic  iron  is  inert, 
yet,  when  it  reaches  the  stomach,  it  is  dissolved  by  the  acids, 
and  thus  acquires  molecular  activity.  By  its  oxidation  in  the 
stomach  hydrogen  is  set  free,  which  in  its  nascent  state  unites 
with  sulphur,  forming  sulphuretted  hydrogen. 

Medical  Properties  and  Action. — The  salts  of  iron  act 
through  and  upon  the  blood,  improving  its  quality  and  in- 
creasing its  quantity,  and  hence  they  are  termed  "  haema- 
tinic."  These  salts  of  iron  are  absorbed  into  the  system,  and 
are  detected  in  the  blood,  urine,  etc.,  and  under  their  use  the 
appetite  increases,  the  digestion  is  improved,  the  pulse  in- 
creases in  frequency  and  fullness,  the  health  becomes  better, 
and  there  is  an  increase  in  flesh  and  an  improvement  in  color; 
hence  they  are  "  restoratives."  As  these  salts  of  iron  in  large 
doses  cause  nausea  and  vomiting,  being  irritant  poisons,  and 
even  small  doses,  when  administered  for  a  long  period,  exhaust 
the  gastric  glands  by  over-stimulation,  their  use  is  con1;ra-indi- 
cated  in  a  plethoric  condition,  especially  when  accompanied 
with  a  hemorrhagic  tendency,  or  when  there  is  an  athero- 
matous state  of  the  cerebral  vessels.  Certain  of  these  salts, 
such  as  the  sulphates,  the  chlorides,  and  the  nitrates,  possess 
a  high  degree  of  astringency,  and  when  taken  internally  pro- 
duce constipation.     Brought  in  contact  with  the   blood,  they 


IRON.  373 

coagulate  it,  and  solidify  the  albuminous  elements  of  the  tis- 
sues, being-  powerful  "  haemostatics. " 

Without  great  care  is  exercised  in  the  internal  administra- 
tion of  iron,  owing  to  the  acidity  and  astringent  property  of 
many  of  these  preparations,  injury  results  to  the  teeth,  upon 
which  they  act  with  great  energy.  The  tincture  of  the  chlo- 
ride and  the  sulphate,  as  shown  by  the  experiments  of  Dr. 
Smith,  of  Edinburg,  Scotland,  are  more  corrosive  than  the 
wine  of  iron,  and  even  more  injurious  than  the  compounds  of 
iron  with  the  vegetable  acids.  The  use  of  an  alkaline  gargle 
of  carbonate  of  soda,  or  prepared  chalk,  or  solution  of  ammo- 
nia, before  and  after  the  taking  of  the  iron  preparation  into 
the  mouth,  and  the  subsequent  employment  of  an  antacid 
dentifrice,  will  obviate  the  injurious  effects  of  these  salts  of 
iron  upon  the  teeth.  While  the  carbonate  of  iron  in  the  form 
of  pill,  nor  the  reduced  iron,  are  injurious  to  the  teeth  by 
direct  action,  yet  eructations  of  hydrogen  compounds  pro- 
duced by  their  ingestion  may  injure  the  teeth. 

The  use  of  a  tube  carried  well  back  in  the  mouth  and  the 
iron  preparation  well  diluted,  should  be  preceded  and  followed 
by  the  alkaline  solution.  The  preparation  known  as  dialysed 
iron — Ferriwi  Dialysatuvi — which  is  iron  in  the  colloid  state, 
made  by  the  process  of  diffusion,  is  odorless,  without  the 
styptic  taste  of  the  other  preparations,  and  does  not  discolor 
the  teeth,  being  free  from  irritant  action  ;  neither  does  it  cause 
constipation,  and  hence  it  is  the  best  form  in  which  to  admin- 
ister iron.     The  dose  of  dialysed  iron  is  TVLv  to  5j. 

Therapeutic  Uses  of  Iron. — Iron  is  an  efficient  tonic,  and 
promotes  the  appetite  and  the  digestion  ;  hence  it  is  employed 
in  anaemia,  chlorosis,  combined  with  quinine  in  chronic  mala- 
rial affections,  syphilitic  cachexia,  acute  rheumatism,  ery- 
sipelas, diphtheria,  scrofula,  rickets,  neuralgia  depending  on 
anaemia,  epilepsy  in  weak,  anaemic  subjects,  fatty  degenera- 
tion of  the  heart,  passive  forms  of  hemorrhage  due  to  anaemia, 
albuminuria,  etc.,  etc.  Externally,  the  styptic  preparations  of 
iron  are  employed  to  arrest  hemorrhage — hemorrhage  from 
leech  bites,  hemorrhage  following  the  extraction  of  teeth,  hem- 


374  DENTAL  MEDICINE. 


orrhage  resulting  from  wounds  and  surgical   operations,  etc., 
etc. 

[For  doses  of  the  various  preparations  of  iron,  see  "  Table  ■ 
of  Doses."] 

Chloride  of  Iron — Ferri  Chlofidum — Perchloride  of  iron. 
Formula,  FegClg,  is  obtained  by  heating  iron  wire  with  hy- 
drochloric acid,  and  afterwards  converting  the  ferrous  chloride 
thus  formed  into  ferric  chloride  by  heating  it  with  hydro- 
chloric and  nitric  acids.  It  is  in  the  form  of  crystalline 
masses  of  an  orange  yellow  color,  inodorous  and  of  a  strong 
styptic  taste.  It  is  deliquescent  and  readily  soluble  in  water, 
alcohol  and  ether.  It  is  used  internally  in  the  form  of  a  tinc- 
ture— Tinctiira  Ferri  Chloridi.     Dose,  TIXv-xx. 

Externally  the  chloride  of  iron  is  employed  as  a  styptic  and 
for  an  astringent,  for  the  latter  purpose  being  in  solution  of 
various  strength. 

Dental  Uses. — In  dental  practice  the  chloride  of  iron  is  used 
internally  for  the  treatment  of  neuralgia  when  it  is  attended 
with  anaemia ;  also  externally,  for  the  arrest  of  alveolar  hem- 
orrhage, although  the  preference  is  given  to  the  solution  or 
powder  of  the  subsulphate.  The  chloride  of  iron  may  be 
used  in  the  semi-deliquesced  or  crystallized  form,  or  in  solu- 
tion— Liquor  Ferri  Perchloridi — which  is  preferred  by  some  to 
the  crystallized.  To  bleeding  surfaces  it  is  applied  in  the 
proportion  of  3ss  to  5vj  to  the  ounce  of  water.  One  part  of 
the  chloride  gradually  added  to  six  parts  of  collodion,  in  the 
form  of  a  yellowish-red,  limpid  liquid,  makes  a  valuable  styp- 
tic. Chloride  of  iron  is  also  useful  as  an  application  to 
fungous  tumors. 

Reduced  Iron — Ferritin  Reductuni — is  metallic  iron  in  the 
form  of  a  fine  powder,  obtained  by  the  reduction  of  ferric  oxide 
by  hydrogen.     Dose. — Gr.  j  to  gr.  v. 

Solution  of  Subsulphate  of  Iron — Liquor  Ferri  Subsul- 
phatis — Monsel's  Solution — Forinida  :  2  Fe203(S04)3. — is  com- 
posed of  sulphate  of  iron,  Sxij  ;  sulphuric  acid,  oj,  and  gr. 
XXX ;  nitric  acid,  gr.  ccclx.  It  is  of  a  syrupy  consistence  and 
a  ruby  red  or  dark  brown  color,  no   odor  or  acrid  taste,  but 


IRON.  375 

possesses  powerful  astringent  properties.  When  employed 
for  the  arrest  of  alveolar  hemorrhage  from  tooth-extraction 
it  is  liable  to  cause  sloughing  of  the  bleeding  tissues,  and  if 
used  it  should  be  in  weak  solution,  and  carefully  watched. 

Powdered  Subsulphate  of  Iron — Pidvis  Ferri  Subsul- 
phatis — Monsel's  Powder — is  in  the  form  of  a  yellow  powder, 
and  possesses  the  same  astringent  and  other  properties  as  the 
solution,  and  is  applied  as  a  styptic  in  alveolar  hemorrhage 
with  much  greater  convenience. 

Medical  Properties  and  Action. — Monsel's  solution  and  powder 
act  topically  as  powerful  astringents  and  mild  caustics,  and  are 
considered  to  be  among  the  best  styptics  in  use.  These  styp- 
tics combine  with  albumen  and  form  a  pale  yellow  compound, 
and  on  this  property  depends  their  chemical  action  on  the 
tissues  of  the  body.  Internally  administered  they  act  like  the 
sulphate  of  iron,  their  remote  effect  being  tonic  and  haemo- 
static. In  small  doses  they  exert  an  astringent  effect  on  the 
gastro-intestinal  mucous  membrane,  diminishing  the  quantity 
of  fluids  secreted  or  exhaled;  hence  their  continued  use  will 
cause  constipation. 

Monsel's  preparations  of  iron  are  principally  used  externally 
for  hemorrhage  from  bleeding  vessels.  When  employed 
internally  it  is  for  the  arrest  of  hemorrhage  from  remote  organs. 

Therapeutic  Uses. — The  solution  and  powder  of  the  sub- 
sulphate  of  iron  are  used  internally  for  hemorrhage  from  the 
stomach  and  bowels.  Externally,  for  hemorrhage,  varicose 
ulcers,  etc.,  etc. 

Dose. — Of  the  solution  of  subsulphate  of  iron,  gtt.  v  to  gtt. 
X,  twice  a  day  in  some  bitter  infusion.  Of  the  powdered  sub- 
sulphate of  iron  the  dose  is  gr.  v  to  gr.  xv.  The  solution  is 
also  given  in  small  doses  with  the  sulphate  of  magnesia,  and 
as  an  artificial  chalybeate  purging  water. 

Dental  Uses. — In  dental  practice,  Monsel's  solution  and 
powder  are  principally  employed  for  arresting  hemorrhage 
following  the  extraction  of  teeth,  hemorrhage  from  leech  bites, 
and  also  from  other  causes,  such  as  wounds  of  the  gums  and 
mucous  membrane,  in  the  treatment  of  ulcers  of  the  mouth; 


376  DENTAL  MEDICINE. 


and  the  solution,  diluted  with  water,  forms  a  serviceable  ap- 
plication for  abraded  and  inflamed  mucous  surfaces. 

For  Hemorrhage  following  the  Extraction  of  Teeth. 
— After  carefully  cleansing  the  bleeding  cavity  as  thoroughly 
as  possible,  the  styptic  should  be  applied  on  a  pellet  of  cotton, 
or,  in  case  the  powdered  subsulphate  of  iron  is  employed,  on 
a  pellet  of  cotton  previously  dipped  in  sandarach  varnish,  to 
which  the  powder  will  adhere,  and  inserted  over  the  mouth  of 
the  bleeding  vessel  at  the  apex  of  the  alveolar  cavity.  Cotton 
should  then  be  inserted  over  the  styptic  preparation,  and  the 
alveolar  cavity  be  thoroughly  filled  up.  If  necessary,  a  com- 
press, made  from  a  cork,  or  softened  modeling  composition, 
should  be  applied  over  the  cotton  filling  the  cavity  and  held 
in  place  by  the  opposing  teeth,  when  the  mouth  is  closed. 

DENTAL  FORMULAE. 

For  Hemorrhage  from   Extraction  of  Teeth. 

Steere. 
R.        Liq.  ferri  persulph., 

Sodium  cUor aa  partes  sequales.  M. 

SiGNA. — Apply  on  cotton  to  bleeding  cavity  and  secure  by  covering 
with  a  roll  of  cotton  cloth. 
I 
For  Hemorrhage  after  Lancbtg  Gu??is  of  Children. 

Dr.  J.  W.  White. 
"Where  oozing  of  blood  persists  in  spite  of  local  treatment : 

R.        Tinct.  ferri  chloridi fo^^ 

Acid,  acetic  dil f^j 

Liq.' ammonii  acet fgj 

Ext.  ergot,   fid , f^ij 

Syr.  simp f.5ss 

Aquas  q.s.  ad f^iij-  M. 

SiGNA. — A  teaspoonful  every  3  hours  for  a  child  6  months  old. 

FORMALIN— FORMALINE. 

Derivation. — Formaline  is  derived  from  formaldehyde,  the 
gas  given  off  from  formic  aldehyde.  A  solution  of  forty  per 
cent,  strength  of  the  gas  formaldehyde  is  known  by  the  name 
of  formaline.  It  mixes  in  all  proportions  with  water,  and  a 
solution  of  any  required  strength  can  be  readily  made. 


WINTERGREEN.  377 


Medicinal  Properties,  etc. — The  germicidal  and  antiseptic 
action  of  formic  aldehyde  was  demonstrated  by  Low,  Aronson, 
Berlioz  and  Frillat;  also  by  I.  Stahl,  who  found  that  formaline 
is  equal  in  germicidal  power  to  corrosive  sublimate,  and  under 
certain  conditions  superior  where  albuminoid  solutions  are 
concerned.  In  large  rooms  and  delicate  articles  in  closed 
apparatus,  a  2.5  volume  per  cent,  of  formaline  in  the  air 
destroyed  all  micro-organisms  in  a  quarter  of  an  hour.  When 
allowed  to  evaporate  in  the  presence  of  wool,  gauze-bandages, 
or  other  dressing  material,  the  vapors  of  formaline  condensed 
upon  the  fabrics  in  solid  form  (paraformalin)  and  so  disinfected 
them.  Hence  dressing  materials  impregnated  with  formaline, 
become  perfectly  sterile,  but  can  be  immediately  used  as  anti- 
septic dressing. 

Formic  aldehyde  is  relatively  non-poisonous,  but  when 
brought  in  contact  with  the  skin  undiluted,  causes  a  tanning 
effect,  making  it  impermeable,  and  finally  causing  necrosis. 
This  action  is  due  to  the  property  formaline  possesses  of 
readily  penetrating  living  and  dead  tissue,  and  combining 
with  it.  Formaline  attacks  only  the  substance  of  the  con- 
tagious material,  leaving  intact  the  articles  treated,  whether  of 
organic  or  inorganic  nature.  It  is  also  verj^  readily  employed 
under  all  circumstances,  either  in  liquid  or  gaseous  form.  Its 
specific  gravity  closely  approximates  that  of  air,  hence  its 
power  of  keeping  the  atmosphere  of  an  enclosed  space  uni- 
formly impregnated  with  formaline  vapor. 

GAULTHERIA— WINTERGREEN. 
PARTRIDGE  BERRY— TEA  BERRY. 

Source. — Gaultheria  is  obtained  from  the  leaves  of  the 
gaiilthericB  procumbens  (Ericaceae),  a  small  plant  common  to 
the  woods  of  North  America.  The  leaves  contain  a  volatile 
oil,  arbutin,  urson,  ericolin,  tannic  acid,  etc.,  and  the  taste  is 
aromatic,  somewhat  bitter,  and  astringent.  The  volatile  oil 
consists  principally  of  gaultherilene  and  methyl  salicylate, 
which  yield  a  pure  salicylic  acid. 

Oleum  Gaultherice. — The  oil  of  gaultheria  is  antiseptic  and 


378  DENTAL  MEDICINE. 

antipyretic,  and  is  administered  in  doses  of  Hlx-xx  in  artic- 
ular rheumatism,  and  locally  is  used  as  an  antiseptic  in  wounds 
and  cystitis.  The  spirit  of  gaultheri-a — spiritus  gaidtherice — is 
used  for  flavoring.  The  infusion  is  used  as  a  gelactagogue 
and  enimenagogue,  and  is  often  added  to  liniments  for  rheu- 
matic pains  and  swollen  joints. 

Dental  Uses. — The  oil  of  gaultheria,  one  of  the  essential  oils, 
is  used  in  dental  practice  as  an  antiseptic,  either  alone  or  more 
generally  in  combination  with  other  agents  in  the  treatment  of 
putrid  root  canals,  alveolar  abscesses,  etc.,  and  as  an  ingredient 
of  local  anaesthetic  mixtures. 

DENTAL   FORMULA. 

For  Abscesses  and  Putrid  Root  Canals. 

Dr.  Black. 

R  .         Carbolic  acid  (melted  crystals) I  part 

Oil  of  cassia 2  parts 

Oil  of  gaultheria 3  parts,        M. 

This  is  the  i,  2,  3,  mixture. 

Local  Anasthetic. 

De  Kay. 

R.        01.  gaultherise gij 

Chloroformi ^j 

Ether  sulph • ^j 

Chloral  hydrat ^ij 

01.  caryophylli g;iv 

Alcoholis g  iss.  M. 

SiGNA. — Apply  with  cotton,  pressed  upon  each  side  of  the  tooth. 

GELSEMIUM— YELLOW  JASMINE. 

Source. — Gelsemium  is  obtained  from  the  root  of  the  gel- 
seniium  seinpervirens — yellow  jasmine — woodbine,  belonging 
to  the  natural  order  Apocynaceae,  which  grows  plentifully  in 
the  southern  United  States.  The  root  is  of  a  brownish  color 
externally,  and  a  grayish  color  within,  and  is  sold  in  small 
pieces,  from  one-half  to  two  inches  in  length,  and  a  quarter  of 
an  inch  in  thickness,  being  hard  and  slightly  cracked  longi- 
tudinally. It  has  a  bitter  taste,  and  an  aromatic  odor,  some- 
what like  that  of  green  tea. 


YELLOW  JASMINE.  379 


Medical  Properties  and  Action. — Gelsemium  has  a  depress- 
ing and  sedative  influence  upon  the  nervous  centres,  and  dimin- 
ishes the  force  and  frequency  of  the  heart's  action.  It  con- 
tains a  very  powerful  alkaloid,  gelsemia  or  gelscniina,  which 
is  colorless,  odorless,  with  an  intensely  bitter  taste. 

Gelsemium,  in  moderate  doses,  causes  a  languid  feeling, 
attended  with  mental  calmness,  slow  action  of  the  heart,  droop- 
ing eyelids,  dilatation  of  the  pupil,  and  some  feebleness  of 
muscular  movements.  In  larger  doses  it  causes  vertigo, 
double  vision,  amblyopia,  paralysis  of  the  muscle  that  elevates 
the  upper  eyelid,  so  that  it  cannot  be  raised,  dilated  pupil, 
labored  respiration,  on  account  of  its  effect  upon  the  respira- 
tory muscles,  slow  and  feeble  movement  of  the  heart,  great 
muscular  weakness,  and  a  reduced  sensibility  to  pain  and 
touch.  Such  effects  occur  about  half  an  hour  after  the  gelse- 
mium is  taken,  and  continue  for  two  or  three  hours,  when  they 
disappear. 

When  poisonous  doses  are  taken,  all  of  the  symptoms  de- 
scribed above  occur  in  a  more  intense  degree,  and  there  is  first 
an  unsteady  gait,  until  all  muscular  power  is  lost,  the  lower 
jaw  drops,  the  muscles  of  the  tongue  are  paralyzed,  speech 
being  impossible,  the  respirations  are  very  labored,  slight  and 
irregular,  and  the  action  of  the  heart  weak,  feeble  and  intermit- 
tent, and  generally  the  skin  is  covered  with  a  profuse  perspira- 
tion. Death  occurs  from  asphyxia,  but  consciousness  is 
preserved  until  near  the  end,  which  is  generally  calm,  and  not 
disturbed  by  convulsions. 

Therapeutic  Uses. — Gelsemium  is  internally  administered  in 
tetanus,  mania,  convulsive  or  spasmodic  cough,  such  as 
whooping  cough,  pneumonia,  remittent  and  typho-malarial 
fevers,  ovarian  and  other  forms  of  neuralgia,  cerebro-spinal 
meningitis,  pleuritis,  etc.,  etc. 

Dose. — Of  the  fluid  extract  of  gelsemium — Extractuin  Gcl- 
semii  Fhddiim — the  only  officinal  preparation,  lllv  to  ll^xv. 
Of  the  tincture  of  gelsemium — Ti/ictJira  Gelsemii — (gelsemium 
oiv,  alcohol,  Oj),  the  dose  is  gtt.  x  to  gtt.  xx.  The  fluid 
extract  is  preferable   for  administration;    but  one   fluidrachm 


380  DENTAL   MEDICINE. 


of  this  has  caused  death.     Dose  of  the  alkaloid  gelseniia,  gr. 
eV  to  gr.  aV- 

Dental  Uses. — Gelsemium  is  greatly  extolled  as  a  remedy 
for  neuralgia  of  the  fifth  nerve,  often  affording  permanent  re- 
lief, especially  when  the  affection  is  associated  with  diseased 
teeth.  The  dose  may  be  repeated  at  any  time  after  an  hour 
and  a  half,  if  the  pain  is  not  relieved;  a  third  dose  is  seldom 
required.  In  neuralgia  of  the  face  or  head,  three-minim  doses 
of  the  tincture  of  gelsemium  every  half  hour,  will  often  act 
very  beneficially,  and  leave  no  ill  effects.  Owing  to  the  toxic 
effects  of  this  drug,  care  is  necessary  that  the  dose  is  a  moder- 
ate one,  and  the  symptoms  carefully  observed. 

DENTAL  FORMULAE. 
For  Neuralgia  from  Devitalized  Teeth.       SiGNA. — Give   I  to  3   pills  to  an  adult 
R.    Tinct.  gelsemii   .    .    .   gtt.x  in  the  24  hours. 

Tinct.  aconiti ....   gtt.v 

Aquae ^iv.        M.  For  Dentalgia. 

SiGNA. — One  teaspoonful  every  hour. 

R .    Tinct.  gelsemini .    .    .  TTLxv 

For  Odontalgia,  Internal  Remedy.  t^-     ^  r     •         -ui     •     i^vi 

°     ^  •'  1  met.  fern  perchlori  .  \\\j^ 

Dr.  Dunoycer.  Syr.  aurantii  .    .    .    .  gss 

R,    Gelsemine i  milligr.  Aquae ad  5J.  M. 

Aconitine  (cryst.)  .    .    .  ^  milligr.  SiGNA. — For  I  dose.     To  be  repeated 

Valerianate  of  quinine  .    5  centigr.  thrice  daily. 

For  one  pill. 

GLYCERINUM— GLYCERIN, 

Formula. — C3Hg(OH)3.     Sp.  gr.  1.25. 

Source. — Glycerin  is  obtained  from  the  saponification  of 
fats  and  fixed  oils,  and  contains  a  small  percentage  of  water. 
It  is  a  colorless,  inodorous,  syrupy  liquid,  of  a  sweet  taste, 
and  freely  soluble  in  water  and  alcohol,  but  not  in  ether  or 
chloroform. 

Medical'  Properties  and  Action. — Glycerin  is  nutrient  and 
emollient,  possessing  considerable  power  as  a  solvent  and  pre- 
servative. The  addition  of  ^,  ^,  or  even  xV  part  of  glycerin 
to  a  lotion  or  poultice,  or  an  external  application,  renders  it 
particulary  emollient  and  soothing.  It  keeps  the  parts  moist- 
ened and  soft,  and  corrects  or  prevents  the  disagreeable  odor 


GLYCERIN.  381 


of  discharges,  and  it  does  not  evaporate  or  dry  at  an  ordinary- 
temperature.  Glycerin  dissolves  carbolic  acid,  creasote,  tannic 
acid,  borax,  iodine,  quinine,  iodine  of  potassium,  gallic  acid, 
etc.,  and  its  uses  as  a  solvent  and  a  vehicle  for  other  remedies 
are  very  numerous.  It  has  been  prescribed  as  a  substitute 
for  cod-liver  oil,  where  the  latter  nauseates.  Officinal  solu- 
tions of  medicinal  agents  in  glycerin  are  known  as  glycerites 
[glyceritd). 

Therapeutic  Uses. — Glycerin  is  rarely  used  alone  as  an  inter- 
nal remedy,  its  chief  use  being  external,  or  in  combination 
with  other  medicinal  substances.  It  has  been  prescribed  in 
phthisis,  diabetes,  acne;  externally,  as  an  emollient  in  acute 
coryza,  chronic  follicular  pharyngitis,  chapped  hands  and  face, 
fissures,  skin  diseases,  dressing  for  wounds  and  ulcerated  sur- 
faces, and  as  a  vehicle  for  the  application  of  astringents  to  the 
eye ;  also  to  soften  cerumen  and  for  the  removal  of  insects 
from  the  ear,  and  for  diminishing  the  secretion  of  pus  ;  also 
in  burns,  abraded  surfaces,  erysipelas,  etc.  It  has  also  been 
employed  in  smallpox  as  an  emollient  and  to  prevent  pitting, 
a  mixture  of  one  part  of  glycerin  and  two  parts  of  rose  water 
being  applied,  after  the  pustules  have  broken  and  the  discharge 
has  commenced  to  dry.  It  is  applied  for  a  few  days  until  the 
scabs  begin  to  loosen.  Glycerin  is  also  used  in  croup,  locally 
applied  to  the  glottis ;  also  in  deafness,  where  the  auditory 
canal  is  dry  and  inelast-ic.  For  an  emollient  application  it  is 
frequently  combined  with  other  agents,  and  used  in  the  form 
of  an  ointment  or  embrocation.  Five  parts  of  glycerin  rubbed 
up  in  a  mortar  with  four  parts  of  yolk  of  Qgg,  forms  a  com- 
pound which  prevents  the  action  of  the  air  on  irritated  broken 
or  abraded  surfaces,  and  is  soothing  in  erysipelas,  cutaneous 
affections,  etc.  Although  glycerin  is  so  bland  in  its  general 
character,  yet  it  produces  a  smarting  sensation  when  first 
applied  to  an  abraded  surface  of  the  skin ;  such  an  effect  is 
thought  to  be  due  to  the  affinity  of  glycerin  for  moisture, 
which  it  abstracts  from  the  skin  so  rapidly  as  to  cause  the 
smarting  sensation  ;  mixing  the  glycerin  with  a  little  water 
will  obviate  this.     Pure  glycerin,  when  mixed  with  water,  will 


382  DENTAL   MEDICINE. 

raise  the  temperature  eight  or  ten  degrees,  and  hence  the  two 
should  be  combined  previous  to  the  apphcation. 

Dose. — Of  glycerin,  5j  to  5ij. 

Dental  Uses. — Glycerin  is  a  useful  agent  in  dental  practice 
as  a  solvent  and  emollient,  as  a  solvent  alone,  and  as  both 
solvent  and  emollient,  when  combined  with  other  substances. 

It  is  employed  with  great  benefit  in  such  diseases  of  the 
mucous  membrane  of  the  mouth,  as  the  different  forms  of 
stomatitis,  ulcers  of  the  mouth,  aphthae,  alveolar  abscess, 
abraded  surfaces  from  the  irritation  of  acrid  substances,  arti- 
ficial teeth,  etc. 

In  the  treatment  of  inflamed  and  ulcerated  conditions  of 
the  mucuous  membrane,  it  is  frequently  combined  with  borax, 
and  for  chronic  alveolar  abscess,  after  the  use  of  more  active 
agents,  and  diseases  of  mucous  membrane,  it  is  combined  with 
carbolic  acid,  iodine,  sulphite  of  soda,  etc.  As  an  anodyne 
and  emollient  application,  glycerin  is  combined  with  mor- 
phine, atropine,  acetate  of  lead,  etc.,  etc.  To  form  ointments 
and  embrocations,  it  is  combined  with  gum  tragacanth,  lime 
water,  oil  of  almonds,  rose  water,  etc.,  etc. 

DENTAL  FORMULA. 
For  Chronic  Abscess,   Ulcerations,  etc.       For  Chronic  Alveolar  Abscess,  Ulcera- 

R      Glycerini ^  i  ^^°^^  "f  Mucous  AIe?iibrane,  etc. 

Tinct.  iodi.  comp.  .    .  TTLxlv  R .    Glycerini partem  I 

Acidi  carbolici  cryst.  TTLvj  Acidi  tannici  ....  partes  2. 


Aquae destillatcC  .    .    .  §v.         M. 


For  Pulpitis. 


SiGNA.-Apply    as    a    lotion     or    in-      ^     Glycerini gtt.ij 


gr.v 


J^'^^'^'^-  Acidi  carbolici 

Tr.  aconit.  rad., 
For  Inflammation    and   Ulceration  of  ^^^  ^^^^^^  p-^^    .aa  gtt.ij 

the  Mucous  Membrane.  ^^j^j  ^^^^^j^j  _    _  ^^-^ 

R.    Glycerini gj  01.  menth.  pip., 

Sodii  boratis    .    .    .    .  3  ij.         M.  Ol.  caryophilli   .    .  aa  gtt.xxv.    M. 

SiGNA.— Apply  as  a  lotion.  SiGNA.— Apply  on  cotton. 

For  a  Sedative  Application  in  Inflamed 
For  Aphthous  Ulceration  of  the  Mouth.  Mticous  Membrane. 

R,    Glycerini ^j  R.    Glycerini 

Sodii  sulpliitis    .    .    .  ^j,  Chloroformi  .    .    .  aa  ^ss.         M. 

SiGNA. — Apply  as  a  lotion.  SiGNA, — Apply  as  a  lotion. 


GLYCOZONE.  383 


For  Pulp  Canals  of  Abscessed  Teeth. 
For  Aphthous  Sore  Mouth  of  Infants.  Faught 

R.    Glycerini,  R.    Glycerini f^ij 

Aquffi aagss  Acidi  tannici  .    ...     gij 

Sodium  sulph.     .    .    ,  gr.xxx.   M.  Moi-phiae  acetatis    .    .    ^j 

SiGNA.— Use  on  swab,  every  2  hours.  lodoformi 9J.         M. 

SiGNA. — Apply  on  floss-silk  or  cotton. 

GLYCEROBORATE   OF   CALCIUM. 

Glyceroborate  of  Calcium  is  a  powerful  antiseptic,  and  is 
prepared  by  mixing  equal  parts  of  borate  of  calcium  and 
glycerine,  and  heating  the  mixture  to  about  160°,  with  con- 
stant stirring,  which  is  kept  up  until  a  drop  of  the  mixture 
falling  from  the  end  of  a  stirring-rod  upon  a  glass  plate  solid- 
ifies, on  cooling,  to  a  clear,  odorless,  brittle  bead;  the  mass  is 
then  poured  out,  and  after  cooling,  is  broken  up  and  the  frag- 
ments at  once  put  into  a  well-stoppered  and  dry  bottle.  It  is 
soluble  in  all  proportions  of  water,  and  on  exposure  to  the  air 
will  rapidly  become  liquid,  taking  up  its  weight  of  water. 
Even  when  in  a  very  dilute  solution  it  is  a  powerful  antiseptic, 
with  no  odor  and  no  poisonous  properties. 

GLYCEROBORATE   OF   SODIUM. 

Glyceroborate  of  Sodium  is  prepared  in  the  same  manner  as 
the  glyceroborate  of  calcium,  simply  substituting  the  borate 
of  sodium.  It  possesses  the  same  properties  as  the  glycero- 
borate of  calcium,  and  is  somewhat  preferable  to  the  latter,  as 
even  concentrated  solutions  of  the  glyceroborate  of  sodium 
can  be  applied  to  the  eye  without  inconvenience.  Both  prep- 
arations will  preserve  meat  for  a  long  time. 

GLYCOZONE. 

Derivation. — Glycozone  is  composed  of  chemically  pure 
glycerine  and  peroxide  of  hydrogen.  When  these  two  prep- 
arations are  combined,  the  result  is  a  stable  compound  owing 
to  the  reaction  that  takes  place  when  chemically  pure  glycer- 
ine is  submitted,  under  certain  conditions,  to  the  action  of  fif- 
teen times  its  own  volume  of  ozone,  under  normal  atmos- 
pheric pressure  at  a  temperature  of  0°  C.    The  glycerine  thus 


384  DENTAL  MEDICINE. 


employed  must  be  chemically  pure,  as  the  pressure  of  the 
water  or  other  foreign  matter  in  it  produces  in  the  resulting 
compound  formic  acid,  glyceric  acid,  and  other  secondary 
products  that  have  an  injurious  effect  on  animal  tissue.  Gly- 
cozone  possesses  a  pleasant,  sweetish  taste,  and  causes  a  feel- 
ing of  warmth  when  it  comes  in  contact  with  the  mouth  or 
stomach. 

Medical  Properties  and  Action. — Glycozone  excites  the  sal- 
ivary glands  to  increased  action  and  stimulates  the  gastric 
secretions.  It  attracts  to  itself  water  from  the  adjacent  tissues, 
but  not  sufficient  to  cause  injury,  a  property  due  to  the  gly- 
cerine it  contains.  In  excessive  doses  of  one  or  two  ounces, 
glycozone  causes  epigastric  uneasiness,  followed  by  loose, 
copious,  watery  stools,  which  are  accompanied  by  severe 
cramps.  It  appears  to  have  no  effect  upon  the  kidneys,  liver 
or  heart.  It  is  slowly  decomposed  in  the  stomach,  ozone 
being  liberated  and  the  glycerine  uniting  with  the  water  from 
the  tissues.  It  is  supposed  that  the  morbid  elements  with 
which  it  comes  in  contact  hasten  this  decomposition,  and  in 
so  doing  are  themselves  oxidized  and  destroyed.  The  pres- 
ence of  free  ozone  in  the  stomach  resulting  from  the  decom- 
position of  glycozone  aids  the  digestive  process.  Glycozone 
must  be  kept  in  tightly-corked  bottles,  glass-stoppered  are 
best,  and  when  thus  protected,  it  will  not  deteriorate  at  a  tem- 
perature of  even  iio°  F.  No  metallic  instruments  shquld  be 
brought  in  contact  with  it,  as  such  contact  decomposes  it  \ 
hence  glass  or  hard-rubber  vessels  and  syringes  are  necessary 
when  using  it.  It  resembles  peroxide  of  hydrogen  in  pro- 
ducing a  powerful  oxidizing  effect,  although  its  action  may 
not  be  as  rapid  or  as  energetic  as  the  latter  compound.  It 
therefore  cannot  be  safely  combined  with  other  drugs  or 
chemical  substances  when  prescribing  it. 

Therapeutic  Uses. — Glycozone  is  employed  in  the  treatment 
of  gastric  ulcer,  affections  of  the  stomach,  catarrh  of  chronic 
alcoholism,  chronic  gastric  catarrh  from  other  causes,  and 
atonic  and  acid  dyspepsia.  Externally — when  a  diseased  or 
suppurating  surface  is  cleansed  by  peroxide  of  hydrogen,  the 


HAMAMELIS.  385 


application  of  glycozone  stimulates  healthy  action  and  pro- 
motes recovery.  It  also  checks  the  discharge  of  irritating 
secretions,  and  prevents  infection  from  pathogenic  organisms, 
by  acting  as  a  powerful  antiseptic  and  stimulant.  It  is  also 
useful  in  follicular  pharyngitis,  and  chronic  coryza,  and  croup. 

For  diphtheria  a  tablespoonful  of  glycozone  may  be  given  in 
a  wineglassful  of  water  every  three  hours  with  excellent 
effects  ;  it  is  harmless.  For  membranous  croup,  after  spray- 
ing the  nose,  throat,  larynx  and  pharynx  copiously  every  two 
hours  or  so  with  a  mixture  of  peroxide  of  hydrogen  with  4 
to  6  ounces  of  water,  the  membranes  are  destroyed,  and  then 
one  teaspoonful  of  glycozone,  diluted  in  a  wineglass  of 
water  and  given  three  times  a  day,  will  prevent  any  disturb- 
ance of  the  stomach,  and  will  regulate  the  bowels.  In 
ulceration  and  chronic  inflammation  of  the  intestines,  great 
benefit  is  derived  from  enemata  consisting  of  glycozone  5j, 
and  lukewarm  water  Sxij,  prepared  just  before  using;  also  in 
fistula-in-ano  and  rectal  ulcerations  glycozone  5j  and  luke- 
warm water  Sj,  administered  once  or  twice  daily,  will  produce 
good  results.  For  leucorrhoea,  the  vagina  is  first  washed 
with  peroxide  of  hydrogen  one  part  and  water  four  parts, 
when  glycozone  is  applied  on  small  rolls  of  lint,  or  absorbent 
cotton,  and  the  procedure  repeated  twice  daily. 

Dental  Uses. — Glycozone  is  employed  for  all  forms  of  in- 
flammation and  ulceration  of  the  oral  mucous  membrane,  and 
in  ulcerative  stomatitis  frequent  applications  prove  very  bene- 
ficial. It  is  also  considered  to  be  useful  in  the  chronic  form 
of  alveolar  abscess  in  the  form  of  an  injection  composed  of 
glycozone  and  lukewarm  water. 

HAMAMELIS. 
WITCH  HAZEL. 

Source. — Hamamelis  Virginica  is  an  indigenous  shrub,  com- 
mon to  all  parts  of  the  United  States  and  Canada,  and  usually 
found  in  stony  places  and  on  the  banks  of  streams.  The  bark 
and  leaves  are  the  medicinal  portions. 

Medical  Properties  and  Action. — It  is  tonic,  astringent,  seda- 
25 


386  DENTAL  MEDICINE. 


tive,  and  anodyne.  The  bark  has  a  bitter,  astringent,  and 
somewhat  sweetish  and  pungent  taste,  and  was  first  employed 
by  the  Indians  as  a  sedative  and  discutient  application,  in 
painful  tumors  and  other  cases  of  superficial  inflammation. 
The  bark  contains  from  eight  to  ten  per  cent,  of  tannic  acid, 
and  also  a  bitter  principle. 

Therapeutic  Uses. — Hamamelis  Virginica,  although  not  until 
recently  ofificinal,  has  for  some  time  been  employed  in  hemor- 
rhage of  the  lungs,  haematemesis,  and  in  phthisis.  Externally, 
it  is  applied  to  tumors,  inflamed  and  painful  parts,  etc.,  etc., 
in  the  form  of  a  fluid  extract,  decoction  and  tincture.  Two 
minims  of  the  tincture  of  hamamelis  every  half  hour,  will  often 
control  hemorrhages  from  nose,  uterus  and  from  hemorrhoids. 

Dose. — Of  the  fluid  extract  of  hamamelis,  5ss  to  5ij ;  of  the 
decoction,  oss  to  5J. 

Dental  Uses. — Hamamelis  is  employed  in  dental  practice  as 
a  sedative  or  anodyne  application,  in  incipient  periodontitis, 
in  the  form  of  the  fluid  extract,  applied  warm  on  lint  or 
cotton,  as  a  lotion;  also  as  an  anodyne,  to  irritated  and  painful 
exposed  pulps  of  teeth ;  also  for  passive  hemorrhage  from  the 
mucous  membrane  of  the  mouth;  also  for  the  soreness  arising 
from  the  removal  and  effects  of  salivary  calculus.  The  tinc- 
ture may  be  applied  as  a  sedative  lotion,  in  the  proportion  of 
one  part  to  ten  of  water. 

HYDRARGYRUM— MERCURY. 

QUICKSILVER. 

Symbol. — Hg.     Sp.  gr.  13.5. 

Sources. — Mercury  is  a  metal  of  a  nearly  silver-white  color, 
and  a  very  high  degree  of  lustre.  It  is  liquid  at  all  ordinary 
temperatures,  and  only  solidifies  when  cooled  to  39°  or  40°  F. 
It  boils  at  about  666°  F.,  it  fuses  at  39°  F.,  and  is  slightly 
volatile  at  60°  F. ;  when  boiling  it  yields  a  transparent, 
colorless  vapor,  of  density  of  100.  It  also  volatilizes  some- 
what even  at  ordinary  temperatures,  and  especially  above  68°  F. 
The  ordinary  ore  from  which  metallic  mercury  is  obtained 
is   the   mercuric    sulphide,   although    it   is   occasionally   met 


MERCURY.  387 


with  in  globules  disseminated  through  this  native  sulphide, 
and  which  is  noted  as  cinnabar.  There  is  also  a  form  known 
as  hor7i  silver  or  native  calomel,  and  a  native  amalgam  of 
silver  and  mercury.  California  furnishes  metallic  mercury  of 
a  peculiar  purity,  in  large  quantities.  The  metal  is  obtained 
from  the  sulphide  by  the  process  of  "  roasting."  When  pure, 
metallic  mercury  does  not  readily  tarnish  in  the  air,  and  it  can 
be  purified  by  re-distillation,  or  by  adding  to  it  a  small  quan- 
tity of  a  strong  solution  of  nitrate  of  mercury. 

The  impurities  are  generally  dirt,  dust,  lead,  tin,  bismuth 
or  zinc. 

Dental  Uses. — Metallic  mercury  is  employed  in  dental  prac- 
tice, as  an  ingredient  of  amalgam  filling  material,  being  com- 
bined for  such  a  purpose  with  silver,  tin  and  zinc,  and  some- 
times with  gold  and  platinum,  in  addition  to  the  other  metals 
named. 

Hydrargyri  Chloridum  Corrosivum. — Corrosive  Cliloride 
of  Mercury— ^Corrosive  Sublimate.  Mercuric  Chloride,  Bichlo- 
ride of  Mercury.     Fornuda,  HgCL. 

Derivation. — Corrosive  sublimate  is  obtained  by  subliming 
a  mixture  of  chloride  of  sodium  and  mercuric  sulphate,  the 
latter  made  by  boiling  together  sulphuric  acid  and  mercury ; 
double  decomposition  takes  place,  forming  mercuric  chloride 
and  sulphate  of  sodium.  Corrosive  sublimate  is  in  the  form 
of  colorless  crystals,  or  crystalline  masses,  which  are  inodor- 
ous, fusible  and  sublime  without  residue,  and  of  an  acrid, 
styptic  taste.  It  is  readily  soluble  in  15  parts  of  water,  7  parts 
of  alcohol  and  ether. 

Medical  Properties  and  Action. — It  is  one  of  the  most  active 
salts  of  mercury,  and  is  a  corrosive  poison,  but  the  therapeutic 
dose  now  used  is  less  liable  to  cause  the  disagreeable  and 
dangerous  effects  of  mercury  than  almost  any  other  prepara- 
tion employed  for  the  same  purposes.  It  is  in  the  form  of 
colorless  crystals,  and  is  entirely  soluble  in  water.  Corrosive 
sublimate  is  an  effective  germicide  in  the  strength  of  one  part 
to  2500  parts  of  water,  being  250  times  more  powerful  than 
carbolic  acid.     An  aqueous  solution  of  i  in  20,000  destroys 


888  DENTAL  MEDICINE. 


the  spores  of  bacilli  in  ten  minutes,  and  a  solution  of  1-5000 
is  a  certain  disinfectant,  when  the  exposure  is  very  short, 
and  it  is  now  regarded  as  one  of  the  most  powerful  germi- 
cides in  use  and  is  very  extensively  employed  in  antiseptic 
surgery. 

Dr.  F.  Abbott  regards  the  bichloride  of  mercury  as  being 
the  simplest  antiseptic  in  use.  Dr.  W.  D.  Miller,  of  Berlin, 
also  testifies  to  the  power  of  the  bichloride  as  an  antiseptic  in 
the  treatment  of  the  oral  cavity  as  follows:  "The  experiments 
show  that  bichloride  of  mercury  is  about  two  hundred  times 
as  powerful  as  carbolic  acid,  and  demonstrate  very  clearly 
the  mistake  of  substituting  weak  solutions  of  this  antiseptic 
(i-iooo,  as  I  have  seen  recommended)  for  concentrated  car- 
bolic acid.  One  one-thousandth  is  only  one-fifth  as  powerful 
as  pure  carbolic  acid,  which  in  many  cases  may  be  used  with 
impunity.  It  is  consequently  useless  to  attempt  to  introduce 
the  sublimate  solution  for  the  purpose  of  sterilizing  root-canals, 
cavities  before  filling,  etc.,  unless  we  may  use  at  least  a  y^  per 
cent,  if  not  a  one  per  cent,  solution.  I  see  no  reason  why  this 
may  not  be  done.  In  a  few  cases  I  have  used  a  i  per  cent, 
solution  for  treating  root-canals,  and  do  not  hesitate,  particu- 
larly with  the  rubber  dam  adjusted,  to  wipe  out  cavities  before 
filling  with  a  two  per  cent,  solution,  and  see  no  possible  evil 
which  would  result  from  it."  "As  a  mouth  wash  I  have  fre- 
quently used  a  xV  per  cent,  (i.ooo)  solution  myself,  and  have 
seen  no  bad  results  from  it;  I  would  not,  however,  recom- 
mend it  to  my  patients  in  this  strength." 

It  is  often  employed  in  solution  in  water,  i  part  to  2000, 
which  would  approximate  i  grain  to  4^  ounces  of  water. 

Dr.  Black  recommends  the  following  combination :  Mercuric 
chloride,  gr.  ij ;  peroxide  of  hydrogen,  fSj.  M.  For  use  as  an 
injection  in  alveolar  abscess  and  the  pus  pockets  of  pyorrhoea 
alveolaris.  As  a  solution  of  bichloride  of  mercury  is  prone  to 
undergo  chemical  changes,  powders  or  tablets  containing  equal 
quantities  of  the  bichloride  and  ammonium  chloride  may  be 
prepared  and  a  solution  made  by  adding  one  of  these  to  an 
ounce  of  distilled  water. 


MERCURY.  389 


Another  method  is  to  take  one  drachm  each  of  the  bichloride 
and  hydrochloric  acid,  and  add  enough  of  distilled  water  to 
make  one  ounce,  which  forms  a  permanent  solution,  strong 
enough  in  the  proportion  of  a  teaspoonful  to  a  pint  of  water, 
to  make  a  sterilizing  and  disinfectant  solution  of  i  to  looo,  for 
washing  out  pus  sacs  and  pus  pockets  in  alveolar  abscess  and 
alveolar  pyorrhoea. 

Referring  to  the  bichloride  of  mercury,  benzoic  and  salicylic 
acids  and  listerine.  Dr.  Miller  says  :  Of  these  four,  which  are 
available  for  the  prophylactic  treatment  of  the  oral  cavity,  par- 
ticularly of  the  teeth,  the  bichloride  is,  without  doubt,  the 
most  effective,  because  its  action  continues  longer;  and  he 
further  says :  "  Unfortunately  the  bichloride  of  mercury  pos- 
sesses one  great  disadvantage  in  its  highly  poisonous  char- 
acter. It  seems,  however,  scarcely  possible  that  any  harm 
could  result  from  its  use  in  so  dilute  a  form."  (See  Hydrar- 
gyri  Chloridum  Mite.) 

Passing  chlorine  through  an  alcoholic  solution  of  chloride 
of  mercury  will  prevent  the  decomposition  of  the  latter  when 
exposed  to  light,  or  any  change,  by  loss  of  chlorine,  to  mer- 
curous  chloride. 

Therapeutic  Uses. — Corrosive  sublimate  is  alterative  in  small 
doses,  and  in  large  quantities  it  is  a  powerful  irritant  poison, 
corroding  the  stomach  and  causing  death  in  a  very  few  hours. 
Its  continued  use  has  caused  salivation,  but  it  has  a  less  ten- 
dency to  produce  such  an  effect  than  the  other  preparations  of 
mercury.  Internally  it  is  employed  in  secondary  syphilis, 
chronic  diarrhoea  and  dysentery.  Externally  in  diseases  of 
the  eye,  diseases  of  the  skin,  ulcers,  gonorrhoea  and  gleet,  etc., 
etc.  The  external  application  to  large  surfaces  is  dangerous. 
Its  use  is  contra-indicated  in  patients  affected  with  pulmonary 
disease.  Drs.  Yates  and  Kingsford  report  three  cases  of  can- 
crum  oris  in  children  cured  by  wiping  the  affected  parts  with 
a  solution  of  the  bichloride  of  mercury  (i  to  500)  and  after- 
wards dressing  them  with  lint  soaked  in  a  similar  solution  (i 
to  1000).  Healthy  granulations  soon  made  their  appearance, 
and  the  wound  quickly  contracted. 


390  DENTAL   MEDICINE. 


For  cases  of  poisoning  the  antidotes  are  albumen,  white  of 
egg-,  wheat  flour,  milk,  etc. 

Dose. — Of  corrosive  sublimate  gr.  sV  to  gr.  rsr,  in  pill  or 
solution. 

Dental  Uses. — It  is  employed  as  a  lotion,  injection  or  gar- 
gle, in  chronic  diseases  of  the  mucous  membrane,  ulcers, 
ulitls,  etc.  Dr.  C.  T.  Stockwell  reports  a  case  of  acute  ulitis 
in  which  bichloride  of  mercury,  in  solution  i-iooo,  was  used 
to  bathe  the  parts,  and  the  pockets  about  the  teeth  injected 
with  it,  the  result  being  very  satisfactory  ;  and  the  same  solu- 
tion used  as  a  sterilizing  agent  is  considered  to  be  very 
efficient. 

Test  for  Bichloride  of  Mercury. — Dr.  Chas.  Mayr  recom- 
mends the  following  to  determine  whether  a  solution  of  bi- 
chloride of  mercury  is  still  reliable  or  not :  Saturate  a  nice 
grade  of  paper  with  a  solution  of  a  given  amount  of  iodide  of 
potassium  in  water  ;  with  the  proper  gauging  of  this  solution, 
after  it  has  dried  on  the  paper,  a  drop  of  the  solution  of  the 
bichloride  (l  to  500)  will  produce  a  scarlet  spot  when 
dropped  on  the  paper;  a  solution  of  i  to  lOOO,  a  yellow  spot ; 
a  more  dilute  solution,  no  spot  at  all.  To  obtain  this  result,  a 
certain  strength  of  the  solution  of  iodide  of  potash  gauged 
for  the  paper  to  be  used  is  required.  The  solution  of  iodide 
of  potash  should  be  made  slightly  alkaline,  which  will  prevent, 
to  a  great  extent,  the  paper  from  turning  blue.  Diluting  a 
solution  of  bichloride  of  mercury  with  lime  water  will  remove 
the  disagreeable  taste. 

DENTAL  FORMULiE. 

For  Chronic  Alveolar  Pyorrhcea.  Antiseptic  Solution. 

A.  W.  Harlan.                 -  Emil  Rotter. 

R.    Bichloride  of  mercury  grs.ij  R.    Corrosive  sublimate,  1 

Tartaric  acid  ....  grs.x  to  20,000    ....    gr.j 

Distilled  water   .    ,    .f^iv.      M.  Sodii   chlorid.    .    .    .  gr.vss 

SiGNA. — First   cleanse  with    injections  Acid,  carbolic    i    .    .  gr.xxx 

of  peroxide  of  hydrogen,  and  then  Zinci  chlorid. 

hiject  the  above  with  a  hypodermic  Zinci  carbolat.    .    .  aa  ^YA 

syringe.  Acid,  boric gr.xl 


MERCURY, 


391 


Acid,  salicylic    .    .    .   gr.x 
Thyraoli ....:.  KTLij 
Acid,  citric    ....   gr.ij 
Aquce  .    .    .  q.  s.  ad  i,ooo,oo.  M. 
Said  to  be  powerful,  yet  not  toxic  to 
any    dangerous    extent,   and  to  have  a 
more  potent  effect  on  pyrogenic  microbes 
than  sublimate  in  solutions  of  i  to  looo. 
If    a    weak    solution    is    desired    the 
sublimate  'and    carbolic   acid   may   be 
omitted. 

Antiseptic  and  Stimulant  Mouth  Wash. 
(For  use  especially  in  Alveolar  Pyor- 
rhoea.) 
Dr.  Chas.  B.  Atkinson. 
R.    Hydrarg.  bichlor.  .    .   gr.ij 
Tinct.  calendulas    .    .  ^iv 
Aquae  dest.  q.  s. ;  ad  .  ^  viij.      M. 
SiGNA. — Use  daily. 
To  Disinfect  Softened  Dentine  in 
Ccivities. 
Dr.  a.  W.  Harlan. 
R .    Corrosive  sublimate    .  gr.  ij 


Peroxide  of  hydrogen  ^j 
Tartaric  acid  ....  TTLv. 


M. 


Aqueous  solutions  of  Labarraque's 
solution,  permanganate  of  potash  or 
boro-glycerine,  may  also  answer. 

Prof.  W.  D.  Miller,  of  Berlin,  in  a 
list  of  remedies  with  which  he  made 
careful  experiments,  places  the  relative 
powers  of  well-known  agents  in  pre- 
venting the  development  of  fungi  as 
follows  : 

Bichloride  of  mercury  .  1-100,000 
Peroxide  of  hydrogen  .  I—  50,000 

Iodine i-     6,000 

Iodoform i-     5.0°° 

Salicylic  acid    .    .    .    .  i-     2,000 

Eucalyptus i-     1,600 

Carbolic  acid  ....  I-  1,500 
Chloride  of  zinc  .  .  .  i-  1,250 
Permanganate  of  potash  I—  1,000 
Listerine i-        120 


Hydrargyri  Chloridum  Mite — Mild  Chloride  of  Mercury. 
Calomel.     Mercurous  Chloride.     Formula,  HgCl. 

Derivation. — Calomel  is  obtained  by  subliming  a  mixture  of 
mercurous  sulphate  and  chloride  of  sodium,  a  double  decom- 
position taking  place,  by  which  mercurous  chloride  and  sul- 
phate of  sodium  are  formed.  The  mercurous  sulphate  thus 
employed  is  obtained  by  boiling  mercury  in  sulphuric  acid 
and  triturating  the  resulting  mercuric  sulphate  with  mercury. 

To  remove  any  corrosive  sublimate  which  the  calomel  may 
contain,  it  is  washed  with  hot  distilled  water  until  the  ab- 
sence of  a  white  precipitate  with  ammonia  shows  that  the 
poisonous  ingredient  has  been  removed.  Calomel  is  in  the 
form  of  a  white,  inodorous,  tasteless  powder,  insoluble  in 
water,  alcohol  and  ether,  and  wholly  volatilized  by  heat. 
Calomel  is  incompatible  with  the  alkalies,  and  alkaline  earths 
and  alkaline  carbonates,  with  lead,  copper  and  iron.  When 
nitro-muriatic  acid  is  combined  with  it,  corrosive  sublimate  is 


392  DENTAL   MEDICINE. 


formed ;    neither    should  it  be  given    in    combination    with 
iodine. 

Medical  Properties  and  Action. — Calomel  and  the  other 
mercurials  are  employed  as  alteratives,  sialagogues,  purga- 
tives, diuretics,  etc.,  and  moderate  doses  increase  the  action 
of  the  secreting  glands  and  organs,  stimulating  the  salivary 
glands  in  a  very  decided  manner.  When  large  doses  are  ad- 
ministered the  effects  are  manifested  on  the  gums,  which  be- 
come tender  and  swollen,  the  salivary  glands  take  on  in- 
creased action,  the  saliva  and  buccal  mucus  flow  profusely, 
the  mucous  membrane  of  the  mouth  becomes  inflamed  and 
ulcerated,  the  tongue  swollen  and  the  breath  fetid,  with  a  me- 
tallic, copper  taste,  and  the  teeth  become  loose  ;  such  symp- 
toms constitute  the  condition  known  as  salivation.  When 
the  use  of  the  drug  is  discontinued  these  symptoms  disappear, 
but  the  mucous  membrane  and  gums  are  ever  after  more  sus- 
ceptible to  irritation,  and  the  stability  of  the  teeth  is  more  or 
less  impared,  as  is  shown  by  the  recession  of  the  gums  and 
the  absorption  of  the  alveolar  processes.  In  many  cases  the 
gums,  especially  about  the  necks  of  the  teeth,  remain  some- 
what tumefied,  with  a  tendency  to  ulceration. 

If  the  use  of  the  mercury  is  continued  beyond  the  stage 
which  the  symptoms  just  described  indicate,  or  even  as  the 
effects  of  small  doses  in  persons  very  susceptible  to  the 
influence  of  mercury,  an  excessive  salivation  ensues,  with 
serious  ulceration  of  the  gums  and  mucous  membrane  of  the 
mouth,  loss  of  the  teeth,  and  even  necrosis  of  the  bones  of  the 
jaws.  Mercury  has  also  the  effect  of  causing  considerable 
emaciation,  from  the  absorption  of  fat,  and  sometimes  a  peculiar 
febrile  state  known  as  mercurial  fever ;  and  also  diarrhoea, 
skin  diseases,  rheumatism,  neuralgia  and  disorder  of  nervous 
system.  Mercury,  after  it  is  absorbed,  has  a  decided  effect 
upon  the  blood,  which  it  impoverishes,  destroying  the  red 
blood  globules  (hematine  and  globuline) ;  the  blood  contains 
more  water,  is  more  prone  to  putrefaction,  and  the  unnatural 
fluidity  predisposes  to  hemorrhage,  which  may  become 
danp-erous. 


MERCURY.  393 


TJierapciLtic  Uses. — Mercury  in  the  form  of  calomel,  blue 
mass  {Pilulce  Hydrargyri — pills  of  mercury — mercury  gij ; 
confection  of  rose  Siij,  and  powdered  liquorice  root  oj,)  are 
employed  as  alteratives,  sialagogues,  indirect  tonics  and  chola- 
gogues,  and  purgatives  in  syphilis,  diseases  of  the  skin,  bilious 
derangements,  dyspepsia,  acute  glandular  affections,  diarrhoea 
and  dysentery  of  infants,  hepatic  disorders,  croup  and  mem- 
branous laryngitis,  cholera,  etc.,  etc. 

Dose. — Of  calomel,  gr.  tV  to  gr.  x;  of  blue  pills,  or  mass, 
gr.  ss  to  gr.  XV.  Mercurials  are  administered  by  the  mouth, 
by  inunction,  by  fumigation,  and  by  the  hypodermic  method. 

Mercurial  Ointment — Unguentuin  Hydrargyri.  Blue  oint- 
ment is  made  by  rubbing  two  parts  of  mercury  with  one  part 
of  suet  and  lard  each,  until  the  globules  disappear.  When 
rubbed  into  the  skin,  it  produces  the  constitutional  effects  of 
mercury,  and  is  applied  to  tumors,  syphilitic  sores,  blistered 
surfaces,  and  is  used  to  destroy  pediculi,  and  also  to  prevent 
pitting  in  small-pox. 

Mercury  with  Chalk. — Hydrargyrum  cum  Crela,  a  gray 
powder,  consists  of  mercury,  three  parts,  prepared  chalk,  five 
parts.  It  is  a  gentle  laxative,  when  given  in  full  doses,  and 
is  antacid,  and  employed  chiefly  as  an  alterative  in  infantile 
diarrhoea,  etc. 

Dose. — Of  mercury  with  chalk,  for  adults,  gr.  v  to  xx;  for 
children,  gr.  ss  to  ij,  iij  or  x. 

The  effect  of  mercurial  preparations  upon  children  is  some- 
times very  serious,  as  a  profuse,  or  even  gentle  salivation  will, 
at  times,  cause  mortification  and  destruction  of  the  bones  of 
the  jaw,  the  teeth,  the  cheek,  and  lip;  and  although  such  cases 
may  not  be  common,  yet,  to  avoid  such  a  powerful  action,  the 
gums  should  be  frequently  and  carefully  examined,  when  a 
course  of  such  remedies  is  being  pursued. 

Protiodide  of  Mercury — Hydrargyrum  lodidum  Viride, 
known  also  as  Green  Iodide  of  Mercury — is  prepared  by 
rubbing  mercury  and  iodine  together  with  the  addition  of  a 
little  alcohol.  The  formula  is  Hgl,  and  it  is  in  the  form  of  a 
greenish-yellow  powder,  insoluble  in  water  and  alcohol,  but 


394  DENTAL  MEDICINE. 


soluble  in  ether.  Exposure  to  the  light  partially  decomposes 
it,  when  it  becomes  of  a  dark  olive  color. 

Protiodide  of  mercury  is  internally  administered  in  scrofula 
and  scrofulous  syphilis.  It  exercises  a  specific  influence  over 
the  lymphatic  and  glandular  system.  It  should  never  be 
given  at  the  same  time  as  iodide  of  potassium,  as  it  converts 
it  into  biniodide  and  metallic  mercury. 

Dose. — Gr.  i  to  j. 

Externally,  protiodide  of  mercury  is  applied,  in  the  form  of 
ointment,  to  syphilitic  ulcers,  acne,  pityriasis,  etc.,  etc. 

Biniodide  of  Mercury — Hydrargyri  lodidiim  Riibrum. — 
Red  Iodide  of  Mercury.  Mercuric  Iodide.  A  red  powder 
which  becomes  yellow  when  heated  and  red  again  when  cold. 
It  is  wholly  volatilized  by  heat,  and  condenses  in  scales,  which 
are  first  yellow,  but  afterwards  red.  It  is  insoluble  in  water, 
but  soluble  in  boiling  alcohol  and  solutions  of  iodide  of  potas- 
sium and  chloride  of  sodium.     Poisonous. 

Dose. — Gr.  -h  to  tV.     It  is  a  powerful  germicide. 

Red  Sulphuret  of  Mercury — Hydrargyri  Sulplddiim  Ru- 
bruin. — Vermilion.  Cinnabar.  In  brilliant  crystalline  masses 
of  a  deep-red  color  and  fibrous  texture.  It  is  entirely  volati- 
lized by  heat.  It  is  not  soluble  in  either  nitric  or  muriatic  acid, 
but  a  mixture  of  the  two  acids  will  dissolve  it.  Cases  have 
been  cited  in  support  of  the  asserted  poisonous  effects  of  ver- 
milion, where  it  has  been  used  as  a  coloring-matter  for  dental 
vulcanite,  but  a  careful  analysis  as  well  as  evidence  based  upon 
scientific  investigation,  fails  to  establish  the  truth  of  such  a 
theory.  Vulcanite  composed  only  of  pure  caoutchouc  and 
sulphur,  known  as  "  black  vulcanite,"  possesses  advantages 
over  the  red  vulcanite,  in  being  of  finer  texture,  more  dense, 
and  less  spongy,  and  consequently  less  liable  to  absorb  and 
retain  the  secretions  of  the  mouth,  in  the  case  of  an  artificial 
denture  constructed  of  it. 

DENTAL   FORMULA. 
For  Diarrhaa  of  Dentitiott.  Extract  hyoscyami     .  gr.iij  ad  vj. 

R.    Calomel gr.ij  ad  vj  F.  chart,  No.  vj. 

Cretse  ppt gr.xviij  SiGNA. — One  every  2  or   3   hours,  ac- 

Ipecacuanhse  pulv.     .  gr.ij  cording  to  circumstances. 


IODOFORM.  ■  395 


For  Febrile  Excitement  of  Dentition.  For   Warts,    Condylomata,  etc. 

R-    Calomel gr.ij  ad  iij  ^      Hydrar.  chlor.  corrosi  ^j 

Magnes.  calc.      .    .    .  gr.xxiv  (^^jj^^jj ^j_    Sol,,e_ 

Ipecacuanhse  pulv.     .  gr.ij  to  iij 

F  ch    No  xii  SiGNA. — To  be    applied    as  a  caustic, 


For  Diarrhcsa  of   Teething  Children. 


SiGNA.— One  to  be  given  every  3  hours.  with  a  camel-hair  brush 

For  Venereal  Sore  Mouth  and  Throat. 
R .    Hydrar.  chlor.  corrosi  gr. j 

Mellis  despumati    .    .  f|ss  R-    Hydrargyri  cum  cretae, 
Aquae  destillatEE.    .    .fgiv.       M.  Pulv.  ipecac,  et  opii  aagr.j.         M. 

SiGNA. — To  be  used  as  a  gargle.  SiGNA. — One  powder. 

lODOFORMUM— IODOFORM. 
TERIODIDE  OF  FORMYL. 

Formula. — C  H I3. 

Derivation. — Iodoform  is  a  preparation  of  iodine,  being 
obtained  by  the  action  of  chlorinated  lime  upon  an  alcoholic 
solution  of  iodide  of  potassium,  heated  at  104°  F.,  the  product 
being  iodoform  and  iodate  of  lime,  the  iodoform  being  sepa- 
rated by  boiling  alcohol.  It  is  in  the  form  of  small,  pearly 
crystals,  of  a  yellow  color,  with  an  unpleasant  odor,  like  that 
of  saffron,  and  a  sweetish  taste,  and  soft  to  the  touch.  It  is 
volatile,  and  soluble  in  alcohol,  chloroform,  ether  and  the  fixed 
and  volatile  oils,  but  insoluble  in  water. 

Medical  Properties  and  Action. — Iodoform  has  no  irritant 
action,  and,  in  small  doses  is  tonic,  stimulant,  anodyne,  alter- 
ative and  disinfectant,  having  great  influence  on  the  nervous 
system ;  it  is  also  antiseptic.  In  large  doses,  it  causes  a  form 
of  intoxication,  followed  by  convulsions  and  fatal  effects.  In 
the  form  of  vapor,  it  possesses  anaesthetic  properties,  but  not 
equal  to  those  of  the  general  anaesthetics  in  common  use.  It 
has  also  been  used  as  a  local  anaesthetic,  and  also  as  an  anti- 
septic. Its  odor  can  be  detected  in  the  blood,  the  brain  and 
the  muscles. 

Therapeutic  Uses. — Iodoform  produces  the  constitutional 
effects  of  iodine,  but  is  chiefly  used  externally  for  painful 
cancerous  and  phagedenic  ulcerations,  irritable  ulcers,  ill-con- 
ditioned wounds,  obstinate  skin  diseases,  scrofulous  glandular 
enlargements,  to  allay  the  pain  of  gout  and  neuralgia,  and  for 


396  DENTAL   MEDICINE. 


phthisis,  mixed  with  starch  and  spread  on  paper,  so  that  the 
vapor  may  be  inhaled.  Dusted  over  a  diseased  surface,  it 
allays  pain  and  changes  the  morbid  action.  A  saturated 
solution  of  iodoform  in  chloroform  is  recommended  for  neu- 
ralgia; also  a  saturated  solution  in  any  of  the  essential  oils 
is  used  for  the  same  affection.  In  the  form  of  an  ointment,  it 
is  used  as  an  application  to  irritable  ulcers.  For  ulcerated 
surfaces,  it  may  be  sprinkled  over  the  part,  and  lint,  coated 
with  glycerine,  applied  as  a  dressing. 

Dose. — Of  iodoform,  gr.  j  to  gr.  iij,  three  times  a  day,  in  the 
form  of  a  pill. 

Dental  Uses. — Iodoform  is  highly  recommended  in  dental 
practice,  as  an  antiseptic,  either  alone,  or  what  is  better,  com- 
bined with  eucalyptus  oil.  It  possesses  no  escharotic  property 
sufficient  to  cause  irritation  or  the  destruction  of  parts.  In 
the  treatment  of  alveolar  abscess,  iodoform,  in  combination 
with  oil  of  eucalyptus,  has  given  great  satisfaction ;  also  in  cases 
of  putrescent  pulps,  applied  as  an  injection.  It  is  recommended 
to  be  used  as  follows :  First,  an  injection  of  eucalyptus  oil, 
followed  by  the  introduction  of  the  mixture  of  iodoform  and 
eucalyptus  into  the  root  canal,  on  cotton,  or  on  a  strand  of 
floss  silk,  which  is  charged  by  first  dipping  it  into  the  oil,  and 
then  in  the  iodoform ;  or  the  two  may  be  combined  in  a  solu- 
tion (see  Eucalyptus),  and  in  this  form  introduced  into  the  sac 
or  root  canal.  Dr.  C.  N.  Pierce  recommends  iodoform  ground 
up  with  equal  parts  of  oil  of  cloves  and  oil  of  eucalyptus, 
which  forms  a  substance  of  a  soft  cheesy  consistence,  a  portion 
of  which  can  be  introduced  to  the  inflamed  part,  on  the  point 
of  a  small  broach.  Iodoform  is  also  a  very  serviceable  appli- 
cation in  alveolar  pyorrhoea.  A  saturated  solution  in  euca- 
lyptus oil  is  also  serviceable  as  an  external  application  in  neu- 
ralgia. Iodoform  is  also  employed  as  an  anodyne,  for  the 
relief  of  the  pain  following  the  extraction  of  teeth  affected 
with  periodontitis,  and  alveolar  abscess ;  also  as  an  injection  in 
diseases  of  the  antrum,  and  as  a  packing  for  the  pus  pockets 
in  alveolar  pyorrhoea,  for  which  purpose  it  is  often  combined 
with  oil  of  eucalyptus,  or   oil    of  cinnamon.     Also   for  filling 


IODOFORM.  397 


the  canals  of  pulpless  teeth,  for  which  purpose  a  paste  of 
iodoform  and  carboHc  acid  is  used,  and  allowed  to  remain  for 
a  few  days,  and,  if  no  soreness  follows,  a  permanent  root- 
filling  can  then  be  introduced.  When  iodoform  is  used  alone, 
a  pellet  of  cotton  or  a  strand  of  floss  silk  may  be  dipped  into 
glycerine,  and  the  iodoform  be  thus  taken  up.  Dr.  Francis 
Peabody  recommends  the  application  of  the  vapor  of  crystals 
of  non-agglutinized  iodoform  for  treating  pulpless  and  dis- 
eased teeth,  blind  abscesses,  etc.  The  cylinder  of  a  hot- 
air  syringe  is  partly  filled  with  the  crystals,  and  heated  over 
an  alcohol  flame  or  gas  jet  until  the  crystals'  are  fused.  The 
syringe-point  is  then  placed  in  the  root  and  the  bulb  com- 
pressed, forcing  the  vapor  of  iodoform  into  the  canal,  every 
part  of  which  it  permeates.  The  tubuli  being  filled  through- 
out, and  a  precipitate  deposited,  forming  a  solid,  insoluble 
filling.  The  vapor  penetrates  the  apical  foramen  and  comes 
in  contact  with  the  peridental  membrane  subduing  irritation 
and  inflammation,  gradually  restoring  the  tooth,  and  if  loose, 
rendering  it  firm  in  its  alveolus.  To  disguise  the  unpleasant 
odor  of  iodoform,  it  may  be  incorporated  with  a  little  oil  of 
rose,  as  one  drop  of  the  oil  will  remove  the  odor  of  half  a 
drachm  of  iodoform ;  the  odor  is  also  disguised  by  balsam  of 
Peru,  oil  of  cinnamon,  oil  of  lavender,  or  oil  of  sassafras. 
Three  grains  of  cumurin  (a  derivative  of  the  Tonka  bean) 
will  disguise  the  odor  of  one  drachm  of  iodoform  ;  or  the 
addition  of  attar  of  rose,  one  minim  to  the  drachm  ;  or  of 
essence  of  rose  geranium,  three  or  four  minims  to  the  drachm. 
Creolin  is  also  a  very  good  deodorizer  of  iodoform;  also  aqua 
heliotrope,  for  the  hands  also,  one  or  two  drops  of  creasote  or 
carbolic  acid  to  the  ounce  of  iodoform,  is  also  recommended. 
According  to  some,  it  is  not  a  matter  of  indifference  whether 
iodoform  be  applied  as  a  dressing  for  wounds  and  ulcers,  in 
the  form  of  crystals,  as  amorphous  powder  dissolved  in  ether, 
or  as  an  ointment.  Iodoform  acts  not  only  as  a  chemical 
combination,  allowing  the  escape  of  iodine  in  a  free  state,  but 
it  has  certain  mechanical  properties.  When  the  surface  of  an 
ulcer  or  wound  is  covered  )vith  a  layer  of  iodoform  in  crys- 


398  DENTAL  MEDICINE. 


tals,  a  certain  degree  of  absorption  of  the  fluids  secreted  takes 
place.  These  products  of  secretion  penetrating  the  interstices 
betv/een  the  minute  crystals  of  iodoform  soon  lose  the  liquid 
form,  and  produce  with  them  an  impermeable  crust.  Under 
this  crust  cicatrization  soon  occurs,  without  any  retraction  of 
the  tissues ;  hence  they  suppose  that  the  best  form  in  which 
to  employ  iodoform  for  ulcers  and  wounds  is  that  of  the  crys- 
tals. As  toxic  effects  have  followed  the  internal  administra- 
tion of  iodoform,  it  should  be  prescribed  with  care,  and  also 
the  application  of  it  to  extensive  surfaces  should  be  avoided. 
The  toxic  symptoms  have  been  manifested  as  follows,  the 
maximum  dose  which  caused  them  in  a  certain  case  being 
12^  grains  : 

"  Giddiness,  vomiting  and  deep  sleep,  from  which  the 
patient  could  be  roused  with  difficulty.  The  somnolence  was 
interrupted  by  periods  of  excitement,  each  lasting  several 
hours,  and  was  followed  by  delirium,  intense  headache,  sense 
of  impending  death,  spasmodic  contractions  of  the  facial 
muscles,  and  in  the  case  of  the  younger  patient,  diplopia.  The 
functions  of  the  other  sensory  organs  were  not  disturbed,  and 
the  pupils  presented  a  normal  reaction.  Deep  inspirations 
alternated  with  apnoea  of  about  a  minute's  duration.  After 
five  or  six  days,  the  toxic  symptoms  gradually  lessened  and 
passed  away." 

Iodoform  has  been  used  for  odontalgia,  on  account  of  its 
gently  caustic  and  anodyne  action  on  exposed  pulps  of  teeth. 
Combined  with  arsenious  acid  and  creasote  in  a  devitalizing 
mixture,  iodoform  is  supposed  to  lessen  the  pain  caused  by 
the  arsenical  paste. 

M.  Rummo,  of  the  Academy  of  Science,  regards  iodoform 
as  exerting  an  anaesthetic  action  when  applied  to  wounds,  but 
without  the  power  to  destroy  germs  in  putrescent  matter, 
although  it  prevents  their  development ;  but  dissolved  in  oil 
of  turpentine,  it  will  destroy  bacteria  in  their  fullest  prolifera- 
tion. M.  Sauvat  says  that  iodoform,  when  applied  to  wounds, 
reduces  effusion  and  favors  cicatrization,  and  exerts  an  anaes- 
thetic action ;  but  if  carelessly  used  it  may  cause  erythema  or 


IODOFORM. 


399 


even  erysipelas.  Iodoform  in  powder  is  now  a  popular  dress- 
ing for  wounds.  Iodoform  is  more  easily  dissolved  in  alcohol 
and  ether  if  there  is  camphor  already  dissolved  in  them ;  as 
an  example:  alcohol  will  dissolve  only  i^  per  cent,  of  iodo- 
form, while  a  saturated  solution  of  camphor  will  dissolve  lo 
per  cent.  The  spirits  of  turpentine  will  remove  the  odor  of 
iodoform  from  the  hands. 


DENTAL  FORMULiE. 


New    Methods  for 

Deodorizing 

Iodoform. 

I. — Carbolic  acid  .    .    . 

.  I  part 

Iodoform      .... 

.  2  parts 

Powder  and  mix  well. 

No  change  appears  to 

take  place  in 

the  iodoform,  but  the  odor  is  masked 

by  that  of  carbolic  acid. 

2. — Iodoform     .... 

.  loo  parts 

Oil  of  peppermint  . 

.      5  part 

Oil  of  neroli    .    .    . 

I  part 

Oil  of  lemon  .    .    . 

2  parts 

Tinct,  benzoin     .    . 

2  parts 

Acetic  acid  .... 

I  part. 

Powder  the  iodoform, 

and  mix  thor- 

oughly  with  the  other  ingredients. 
Transfer  to  a  well  stoppered  flask,  and 
keep  at  a  temperature  of  from  I20°  F. 
to  140°  F. ,  over  a  water  bath,  for  2 
days.  The  mixture  has  a  pleasant  odor 
of  Eau  de  Cologne. 

3. — Camphor 5  parts 

Charcoal 10  parts 

Iodoform 15  parts. 

Powder  and  mix  intimately. 

For  Pulplcss   Teeth. 

R.    lodoformi gr.x 

Acidi  tannici  ....  gr.iij 

Glycerini gtt.xv.      M. 

SiGNA. — Apply   on   floss    silk,   or    by 
syringe. 

Preparation. — Rub  iodoform  to  fine 
powder,  in  a  mortar,  and  add  the 
tannin,  and,  after   mixing   thoroughly, 


add  the  glycerin      One  drop  of  oil  of 
cinnamon  will  disguise  the  odor. 

For  Devitalizing  Pulps  of  Teeth. 
R.    lodoformi    .....  gr.v 
Acidi  arsenics    .    .    .gr.x 

Creasoti q.  s.  M. 

To  make  a  paste. 
SiGNA. — Apply  on  cotton,  or  on  point 
of  a  broach. 

For  Futrid  Pulps. 
A.  P.  Johnson, 

R.    lodoformi gr--V 

Camphorse "5% 

Alcoholis 5j. 

Misce  by  dissolving  the  camphor  in 
the  alcohol,  and  then  add  the  iodoform. 
SiGNA. — Use  as  an  injection. 

As  a  capping  for  an  exposed  pulp,  it 
is  suggested  to  dissolve  the  fillings  of 
celluloid  in  the  above  mixture  and  form 
a  thick  paste. 

For  Odontalgia. 

SCHAFF. 

R.    Pulv.  lodoformi  .    .    .  gr.lx 

Kaolin gr.Lv 

Acidi  carbolici    .    ,    .  gr.viij 

Glycerini q.  s. 

Olei  menthpe  piperit   .  gtt.x. 
Triturate    the  iodoform,  kaolin,  and 
oil  of  peppermint,  with  enough  glycer- 
ine to  form  a  thick  paste. 
SiGNA. — Apply  to   exposed  surface  of 
pulp. 


400 


DENTAL  MEDICINE. 


For   Pulpless    Teeth   with  a  Fistulous 
Opening. 
Faught. 

R.    lodoformi Qj 

Acidi  tannici  ....     ^ij 

Glycerini f^'J- 

Morphinae  acetat.    .    .     ^j.         M, 
SiGNA. — Apply  on  floss  silk. 

For   Neuralgia   and   Ttimors   of   the 
Gums. 

R.    lodoformi gr.xv 

Bals.  Peru gr.xxx 

Glycerini  vel  vaselin  .  q.  s.        M. 
To  make  a  solution  or  ointment. 
SiGNA. — To  be  applied  as  a  solution; 
or,    if   the  vaseline    is    used,  as   an 
ointment. 

For  Pulpitis,  as  a   Capping. 
Paschkis. 
R.    lodoformi  pul v., 

Kaolin  pulv.  .    .    .  aa  gr.lx 
Acidi  carbolici  (cryst.)  gr.viij. 


Mix,  and  add  sufficient  glycerine  to 
form  a  paste,  tlien  add  : — 

01.  menth  pip.    .    .    .  gtt.x. 
Signa. — Apply   on    point    of    broach 

over  inflamed,  portion. 

For  Tumors,  Enlarged  Gla7ids,  etc. 
R .    lodoformi    ,    .        .    .  part  j 

Collodii part  x.     M. 

SiGNA. — To  be  applied  as  a  lotion. 

For  Pulpless    Teeth — Canal-Dressing. 

Pierce. 
R .    lodoformi, 

Olei  caryophilli, 

Olei  eucalypti    .    .  aa  ^vj.        M. 
Signa. — Apply  by  injection  or  on  floss- 
silk. 

For    an    Ointment    of   Iodofor7n  and 
Eticalypttis. 

R.  Pulv.  iodoformi  ...  ^ss 
Olei  eucalypti  .  .  .  f^ss 
Vaselin ^iv.        M. 

Signa. — To  be  used  as  an  ointment. 


Tetra-iodo-ethylene-Di-odoform  is  a  substitute  for  iodo- 
form, which  it  resembles  in  chemical  composition,  and  contains 
the  largest  percentage  of  iodine  next  to  iodoform.  Its  formula  is 
C2I4,  and  it  is  regarded  as  a  condensation  product  of  two  mole- 
cules of  iodoform  2CHI3 — 2HI=C2l4.  It  is  prepared  from  acety- 
lene di-iodide,  C2I2,  by  dissolving  in  carbon-bisulphide,  adding 
the  equivalent  of  iodine  and  evaporating.  This  residue  is  insolu- 
ble in  water,  but  can  be  recrystallized  out  of  bisulphide,  chlo- 
roform, benzene,  or  toluene  in  the  form  of  yellow  prisms 
melted  at  192°  C.  It  is  unattacked  by  boiling  nitric  acid,  but 
decomposed  by  alcoholic  potash.  It  is  free  from  the  odor  of 
iodoform. 

lODOL— TETRAIODOPYRROL. 

Formula. — C4liNH4. 

Derivation. — lodol  is  obtained  by  the  action  of  iodine  on 
certain    constituents   of  animal   oil.     It   is    in  the  form  of  a 


lODOL.  401 

grayish-white  powder,  which  becomes  dark  on  exposure  to 
hght. 

It  is  odorless  and  has  little  taste,  and  contains  90  per  cent, 
of  iodine.  It  is  quite  soluble  in  alcohol,  ether,  chloroform, 
carbolic  acid,  olive  oil  and  alkaline  solutions,  but  insoluble  in 
water;  combination  with  an  equal  part  of  glycerine  does  not 
affect  its  properties. 

Medical  Properties  and  Therapeutic  Uses. — lodol  is  anti- 
septic, deodorant  and  anaesthetic.  It  is  an  efficient  germicide 
without  poisonous  effects,  and  is  free  from  the  disagreeable 
odor  and  taste  of  iodoform.  Its  physiological  action  and 
therapeutic  uses  are  the  same  as  those  of  iodoform.  When 
applied  to  an  abraded  or  wounded  surface,  it  can  soon  be 
detected  in  the  urine  and  saliva  ;  also  the  same  effects  are 
apparent  when  it  is  administered  by  the  stomach. 

Its  action  is  slower  than  that  of  iodide  of  potassium,  but 
more  prolonged,  and  its  elimination  is  slower.  It  has  a  slight 
caustic  action,  but  a  larger  quantity  can  be  used  when  it  is 
substituted  for  iodoform  ;  no  quantity  applied  to  a  wound  will 
cause  toxic  symptoms. 

It  is  used  on  wounds,  ulcers,  etc.,  in  the  form  of  an  impal- 
pable powder,  which  is  dusted  on  the  part.  It  is  also  employed 
in  the  form  of  an  ethereal  solution,  and  also  in  solution  with 
alcohol  and  glycerine ;  also  in  the  forms  of  iodol  cotton  and 
gauze,  pastils,  bougies  and  ointments.  It  improves  morbid 
conditions,  and  can  be  advantageously  substituted  for  iodo- 
form. It  has  been  administered  with  good  results  in  the 
treatment  of  laryngeal  tuberculosis  by  insufflation  of  the 
powder  ;  and  the  loss  of  appetite,  so  common  as  a  result  of  the 
use  of  iodoform,  does  not  occur,  ulcers  become  rapidly  clean 
and  the  tendency  to  form  scars  is  scarcely  observed. 

Iodol  is  also  employed  internally,  in  the  form  of  pills  of  3 
grains  in  the  treatment  of  substernal  struma.  In  the  treat- 
ment of  syphilitic  ulcers,  round  ulcers,  suppurating  buboes, 
and  after  opening  the  pustules  of  acne,  it  has  also  given  favor- 
able results,  as  it  lessens  the  secretion,  possesses  great  disin- 
fectant power  and  is  non-irritating. 
26 


402  DENTAL  MEDICINE. 


Dose. — For  internal  administrations,  gr.  y^  to  gr.  v,  in  wafer 
pill,  or  pellet,  or  in  powder. 

Dental  Uses. — Same  as  those  of  Iodoform  (which  see). 

DENTAL  FORMULAE, 

For  a   Topical  Application.  For  Root-Canals  of  Abscessed    Teeth. 

Mazzoni.  Van  Wort. 

R.    lodol   ......     I  part  R.    lodol gr.x 

Alcoholis 1 6  parts  Zinci  oxidi gr.xx 

Glycerini 34  parts.  Vaseline   carbol.    q.  s.  to   form  a 

SiGNA. — Apply    with     a    camel's-hair  thick  paste.                               M. 

brush  or  in  the  form  of  spray.  SiGNA.— Place  in  canal  and  seal  with 

Dental   Varnish.  an  oxyphosphate  filling. 

B.    Saturated  solution   of  p^^,  ^   ^^^.^^^  Application. 

lodol  in  alcohol  .    .  i  part 
Hubbard's      negative  Evaporating  quickly. 

varnish 6  parts.  M.       R .    lodol i  part 

A  good,  quick  drying  varnish.  ^ther.    sulph.     ...  8  parts     M. 

lODUM— IODINE. 

Symbol.' — I. 

Derivation. — Iodine  is  a  non-metallic,  metalloid  element, 
obtained  principally  from  kelp  (made  by  burning  seaweed,  and 
in  the  form  of  impure  soda),  which  is  subjected  to  distillation 
in  iron  retorts,  after  which  it  is  mixed  with  sulphuric  acid  and 
black  oxide  of  manganese.  It  is  evolved  in  the  form  of  vapor, 
which  is  condensed.  The  vapor  is  readily  recognized  by  its 
beautiful  violet  color.  Iodine  is  usually  in  the  form  of  bluish- 
black  crystalline  scales,  with  a  metallic  lustre,  a  strong,  pecu- 
liar odor  and  a  hot,  acrid  taste.  It  is  slightly  soluble  in  water 
and  soluble  in  alcohol,  ether,  solution  of  chloride  of  sodium 
and  a  solution  of  iodide  of  potassium. 

Medical  Properties  and  Action. — Iodine  in  small  doses  is 
alterative,  stimulant  and  tonic,  and  acts  locally  as  an  irritant, 
causing  redness,  itching  and  desquamation  ;  exhaled  in  the 
form  of  vapor,  it  excites  cough  and  warmth  in  the  air  pas- 
sages. Taken  internally  it  excites  a  sensation  of  heat  or 
burning  in  the  stomach,  and  in  large  doses  is  an  irritant  poison, 
inflaming  the  mucous  membrane  of  the  stomach  and  causing 


IODINE.  403 

superficial  eschars.  The  internal  use  of  the  iodides  gives  rise 
to  an  eruption  of  acne,  especially  on  the  face,  thighs  and 
shoulders ;  they  have  also  anaphrodisiac  powers  when  long 
continued.  The  influence  of  the  iodides  in  producing  iodism 
may  be  prevented  by  large  draughts  of  water  being  used 
during  their  administration. 

The  odor  of  iodine  can  be  detected  in  the  blood,  brain  and 
muscles. 

When  combined  with  potassium  its  local  irritant  effect  is 
diminished  ;  hence,  the  preparation  known  as  Iodide  of  Potas- 
sium, Potassii  lodidjim  (obtained  by  treating  an  aqueous  solu- 
tion of  potassa  with  iodine),  is  employed  whenever  the  con- 
stitutional effects  of  iodine  are  desired,  as  the  iodide  of 
potassium  possesses  many  advantages  over  iodine  for  internal 
use,  such  as  being  less  irritant,  and.  for  this  reason  maybe 
administered  in  larger  doses  and  for  a  greater  length  of  time ; 
it  is  also  more  soluble  than  iodine  alone,  and  when  taken  into 
the  stomach  is  absorbed  much  more  rapidly.  The  formula  is 
Ki,  and  it  is  in  the  form  of  white  crystals,  of  an  acrid,  saline 
taste.  Some  persons  are  peculiarly  susceptible  to  the  influ- 
ence of  iodine,  even  small  doses  causing  unpleasant  effects, 
such  as  headache,  vertigo,  derangement  of  the  digestive  or- 
gans, etc. 

Iodide  of  potassium,  like  iodine,  produces  a  very  decided 
effect  on  the  secretions,  increasing  them,  and  occasionally  to 
the  degree  of  ptyalism.  The  antidote  for  poisoning  by  iodine 
is  starch. 

Therapeutic  Uses. — Iodine  and  its  preparations  are  valuable 
resolvents  in  the  treatment  of  glandular  enlargements,  indura- 
tions, tumors,  thickening  of  membranes,  etc.,  etc. ;  also  in 
scrofula,  scrofulous  ophthalmia,  tubercular  meningitis,  ad- 
vanced stage  of  pleurisy,  chronic  affections  of  the  liver, 
etc.,  etc. 

Iodide  of  potassium  is  much  employed  in  mercurial  poison- 
ing and  in  syphilis,  especially  in  the  secondary  and  tertiary 
forms,  and  after  the  employment  of  mercury  has  proved  use- 
ful ;  also  in  affections  of  the  nervous  system  of  a  syphilitic 


404  DENTAL   MEDICINE, 


origin,  together  with  the  other  affections  already  referred  to  as 
indicating  iodine.  Externally  iodine  is  used  in  the  form 
of  tincture  in  the  treatment  of  enlarged  scrofulous  glands, 
cutaneous  affections,  erysipelas,  rheumatism,  gout,  phlegmons, 
syphilitic  gummatse  and  nodes,  phagedsenic  ulcerations,  car- 
buncles, diseases  of  the  joints,  wounds  and  parts  poisoned; 
and  as  a  counter-irritant  in  pneumonia,  phthisis  and  pleurisy ; 
and  as  injections  in  hydrocele  and  bronchocele.  The  vapor  is 
inhaled  with  benefit  in  chronic  bronchitis  and  phthisis.  Iodine 
also  ranks  highly  as  a  disinfectant. 

Dose. — Of  iodine  alone,  gr.  ^  to  gr.  j  two  or  three  times  a 
day,  in  the  form  of  a  pill,  directly  after  eating,  on  account  of 
its  irritant  effect ;  the  best  form  of  administration,  however,  is 
iodide  of  potassium.  Dose  of  the  iodide  of  potassium,  gr.  iij 
to  gr.  X.  A  new  way  of  giving  iodine  internally  is  by  dissolv- 
ing iodine  in  water  with  four  times  its  weight  of  iodide  of  po- 
tassium, and  mixing  with  glucose. 

Tincture  of  Iodine — Tinctura  lodiixo^xwQ,  oj ;  alcohol,  Oj). 
Dose,  mj  to  ITLv. 

Compound  Tincture  of  Iodine — Tinctura  lodi  Composita 
(iodine,  oSs;  iodide  of  potassium,  5J ;  alcohol,  Oj).  Dose,  1TLij 
to  TTlx. 

Colorless  Iodine. — Iodine  is  bleached  by  carbolic  acid,  and 
the  colorless  carbolate  combines  all  the  advantages  of  both 
base  and  acid.  One  of  the  easiest  methods  to  decolorize 
iodine  is  to  add  forty  minims  of  a  saturated  solution  of  hypo- 
sulphite of  soda  to  each  fluid  ounce  of  the  tincture  of  iodine. 
Forty  minims  of  the  saturated  solution  contain  about  thirty- 
two  grains  of  sodic  hyposulphite.  Another  method  of  decol- 
orizing iodine  is  to  put  into  an  open  vessel  a  drachm  of  the 
tincture  of  iodine  and  six  ounces  of  hot  water;  add  twelve 
grains  of  phenol,  and  stir  with  a  glass  rod,  when  the  solution 
will  be  at  once  bleached. 

Dental  Uses. — In  dental  practice  iodine  and  its  preparations 
are' valuable  agents,  the  official  and  compound  tinctures  being 
employed  in  the  treatment  of  periodontitis,  alveolar  abscess, 
mercurial  stomatitis  and  other  forms  of  .stomatitis,  inflamma- 


IODINE.  405 

tioti  and  ulceration  of  the  gums,  fungous  growths  of  gum 
and  tooth  pulp,  necrosed  teeth  and  suppurating  pulps  of 
teeth,  diseases  of  the  antrum,  caries  of  maxillary  bones,  den- 
tigerous  cysts,  recession  of  gums  and  absorption  of  alveolar 
processes. 

For  the  different  forms  of  stomatitis,  and  especially  mercu- 
rial stomatitis,  the  tincture  of  iodine  is  used  in  the  form  of  a 
gargle  ;  for  an  injection  in  alveolar  abscess  it  is  diluted  or 
combined  with  carbolic  acid,  glycerine  and  other  agents  ;  for 
fungous  growths  it  may  be  used  alone,  or  combined  with 
rectified  alcohol ;  for  ulcerations  of  gum  and  mucous  mem- 
brane it  is  generally  combined  with  carbolic  acid ;  for  periodon- 
titis it  is  combined  with  the  tincture  of  aconite  root,  and  is 
regarded  as  being  almost  a  specific  for  the  incipient  stages  of 
this  affection,  as  it  relieves  the  inflammation  by  retarding  the 
circulation  and  stimulating  lymphatic  action.  Either  the 
officinal  or  compound  tincture  is  employed  with  an  equal 
quantity  of  the  tincture  of  aconite,  the  preparation  being 
applied  to  the  gum  over  root  of  affected  tooth,  which  should 
be  previously  dried  of  moisture,  by  means  of  a  camel's-hair 
brush  or  cotton  on  the  point  of  an  excavator.  The  mouth 
should  be  kept  open  and  the  part  protected  until  a  metallic 
pellicle  is  formed.  Iodine  is  also  a  valuable  disinfectant  and 
germicide  in  the  treatment  of  alveolar  abscess  (in  the  form  of 
the  compound  tincture),  used  as  injections  throughout  the  pus 
tract,  and  for  root  canals  and  the  pus-pockets  of  alveolar 
pyorrhoea. 

A  valuable  combination  of  iodine,  carbolic  acid,  glycerin 
and  water  is  known  as  "Boulton's  Preparation,"  and  is  a  useful 
application  in  the  form  of  injections,  gargles  and  lotions.  For 
the  chronic  form  of  alveolar  abscess,  and  also  for  the  acute 
form,  after  more  powerful  agents  have  been  employed,  it  is  a 
useful  remedy,  possessing  antiseptic  and  stimulant  properties 
in  a  marked  degree  ;  it  also  possesses  the  property  of  modify- 
ing mucous  membrane  and  diminishing  sensibility ;  hence  it  is 
useful  in  ulcerations,  etc.  Tincture  of  iodine  combined  with 
creasote  or  carbolic  acid  is  a  powerful  application  in  peri- 


406  DENTAL   MEDICINE. 


odontitis,  suppuration  of  necrosed  teeth,  ulceration  of  margins 
of  the  gums  and  for  fungous  growth,  as  it  stimulates  debili- 
tated parts  and  destroys  such  as  are  too  weak  to  be  restored. 
A  colorless  tincture  of  iodine  is  composed  of  glycerin  and 
aqua  ammonia  in  combination  with  the  iodine,  but  the  pres- 
ence of  the  ammonia  restricts  its  use.  Another  colorless 
tincture,  in  which  sulphate  of  soda  is  substituted  for  the  am- 
monia, is  less  irritating  in  its  effects. 

The  addition  of  water  and  honey  to  the  officinal  tincture 
of  iodine  will  render  it  suitable  for  a  gargle  for  inflamed  and 
ulcerated  parts.  The  iodide  of  potassium  is  employed  inter- 
nally in  mercurial  stomatitis,  dental  exostosis,  facial  neuralgia, 
convulsions  of  dentition,  periodontitis,  looseness  of  the  teeth, 
tumefaction  and  sponginess  of  the  gums,  syphilitic  and  scrof- 
ulous ulcerations  of  the  mouth,  caries  and  necrosis  of  the 
maxillary  bones. 

Tincture  of  iodine  mixed  with  glycerin  is  claimed  by  Dr. 
Hammond  to  be  more  effective  as  a  local  application  than  the 
plain  tincture.  This  is  due  to  the  retardation  of  the  dissipa- 
tion of  the  iodine,  or  more  probably  to  the  skin  remaining 
soft,  and  therefore  in  a  better  condition  for  absorbing  the 
drug. 

Iodine  Trichloride  is  formed  by  passing  chlorine  gas  over 
iodine.  It  is  obtained  in  the  form  of  reddish  crystals,  is 
soluble  in  its  own  weight  of  water,  and  almost  as  readily  in 
alcohol,  and  either  solution  can  be  mixed  with  glycerol  with- 
out decomposition.  Dr.  Belfield  regards  it  as  a  powerful 
local  antiseptic  for  irrigating  suppurating  wounds,  and  tuber- 
culous processes.  He  uses  solutions  of  5  to  20  per  cent,  in 
equal  parts  of  water,  alcohol  and  glycerol. 

DENTAL    FORMULiE. 

For  Chronic  Alveolar  Abscess,  Ulcera-  Glycerinae gj 

tions,  Injlammatiotts,  etc.,  etc.  Aqua;  destillatae  .    .    .  gv.         M. 


It  becomes  colorless  in  from  8  to  10 
hours. 
Ji.    Tinct.  iodi.  comp.  .    .  ITtxlv  Signa. — To   be   used   as  an  injection, 


BOULTON. 

3i.  comp.  . 
Acidicarbolici  (cryst.)  X([y]  gargle  or  lotion. 


TRI-CHLORIDE  OF  IODINE. 


407 


For  Ulceration  of  Gtims. 

R .    Tinct.  iodi TTLxlv 

Acidi  carbolici    .    ,    .  1Ti,vj 

Glycerini gj 

Aquae  destillatse  .    ,    •  5  v. 

SiGNA. — Apply  as  a  lotion. 


M. 


For  Periodontitis. 

R.    Tinct.  iodi ^j 

Creasoti  vel., 

Acidi  carbolici        .    .  ^ss.        M. 
SiGNA. — To  be  applied  to  gum  about 
neck  of  tooth,  as  a  counter-irritant. 

For   Ulcerated  Gtcms  and  Mucous 
Membrane. 

R .    Tinct.  iodi partem  j 

Mellis partes  ij 

Aquns partes  vij.   M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Periodontitis. 

R.    Tinct.  iodi ^x 

Potassii  iodidi    .    .    .    ^ss 

Camphorse ^ij 

Spiriti  reclificati .    .    .f^x.        M. 
SiGNA, — Apply    with    a     camel's-hair 
brush  to  gum  over  root  of   affected 
tooth. 

For  Fungous  Growths  and  Suppurating 
Surfaces. 

R.    Tinct.  iodi '7,1] 

Spiriti rectificati  .    .    .   ^j.  M. 

SiGNA. — To  be  applied  with  a  camel's- 
hair  brush. 


For  Mercurial  Stomatitis. 

R .    Tinct.  iodi 5  iij  vel  vj 

Potassii  iodidi    .    .  gr.xv  vel  xxx 
AquK Oss.  M. 

SiGNA. — To  be  used  as  a  gargle. 

For  Periodontitis. 
R.    Tinct.  iodi., 

Tinct.  aconiti     .    .  aa  ^ss.        M. 

SiGNA. — To  be  applied  by  means  of  a 

camel's-hair  brush   until    a    metallic 

pellicle  is  formed,  three  times  daily. 

For  Excessive  Sweating  of  the  Hands. 

R.    Tinct.  iodi 5J 

Lin.  camphouas  comp., 
Glycerinse  .    .    .    .  aa  ^iss 
Lin.  belladonna  comp.  ^  j 
Eau  de  cologne  .    .    .  ^j.  M. 

SiGNA. — Applyas  an  embrocation  twice 
a  day,  having  previously  well  bathed 
the  hands  in  warm  water,  in  which 
is  dissolved  2  drachms  or  half  an 
ounce  of  chloride  of  ammonia  and  4 
drachms  of  carbonate  of  soda  crystals, 
enough  water  being  used  to  well 
cover  the  hands. 

For  Putrescent  Pulps   and  Chronic 
Alveolar  Abscess. 

R.    Iodi gij 

Alcoholis f^ij.        M. 

For  Same  and   Pyorrhea  Alveolaris, 
R.    Iodi, 

Acidi  carbolici  (crys- 
tals)      ^^  3J 

Alcohohs f^ij  M. 


IODINE  TRI-CHLORIDE— TRI-CHLORIDE  OF  IODINE. 

Fonmila. — I CI3. 

Derivation. — Iodine  tri-chloride  is  obtained  by  the  action  of 
chlorine  gas  over  iodine.  It  is  an  orange-red  powder,  whose 
odor  strongly  irritates  the  mucous  membrane.  Usual  dilution 
i:   1200. 

Medical  Properties  and  Therapeutic  Uses. — Tri-chloride  of 


408  DENTAL  MEDICINE. 


iodine  is  antiseptic  and  disinfectant,  being  highly  efficient  as 
such,  through  the  Hberation  of  chlorine,  whose  nascent  ener- 
getic effect  is  still  further  enhanced  by  the  presence  of  iodine. 
The  antiseptic  power  of  tri-chloride  of  iodine  was  officially 
tested  by  the  Imperial  Sanitary  Bureau  of  Germany,  and  the 
following  result  was  ascertained  :  "  An  aqueous  solution  of  i 
in  looo  destroys  resistent  bacillus-spores  within  a  compara- 
tively short  time ;  but  only  the  aqueous  solution  does  this. 
Alcoholic  or  oily  solutions  proved  ineffective.  Iodine  tri- 
chloride far  surpasses  carbolic  acid,  and  is  next  to  corrosive 
sublimate  (bi-chloride  of  mercury),  in  antiseptic  power."  It 
may  be  obtained  in  quantities  of  ten  grammes  in  hermetically 
sealed  tubes,  and  is  best  kept  in  five  per  cent,  aqueous  solu- 
tions which  appear  to  remain  unchanged  for  some  months. 
Langebuch  claims  that  a  o.  i  to  0.15  per  cent,  solution  is  equal 
in  antiseptic  action -to  a  0.5  to  i.o  per  cent,  solution  of  bi- 
chloride of  mercury ;  in  other  words,  that  it  is  about  five 
times  as  efficient  as  the- bi-chloride.  It  is  also  claimed  to  be 
relatively  the  least  poisonous  of  all  antiseptics.  Behring  found 
that  in  aqueous  solutions,  having  equal  action  upon  the  spores 
of  anthrax  bacilli,  sublimate  is  five  to  six  times,  and  carbolic 
acid  and  creasote  seven  to  eight  times,  as  poisonous  as  the 
tri-chloride. 

Dental  Uses. — Dr.  W.  D.  Miller  says:  "We  have  con- 
sequently reasons  to  hope  that  the  tri-chloride  of  iodine  may 
prove  a  valuable  remedy  in  the  treatment  of  diseased  con- 
ditions of  the  teeth  and  mouth."  Its  efficiency  as  a  disinfect- 
ant for  carious  dentine  has  been  clearly  shown  in  the  experi- 
ments of  Dr.  Miller,  and  his  impression  was  that  the  five  per 
cent,  solution  of  the  tri-chloride  of  iodine  is  one  of  the  most 
active  agents  for  sterilizing  carious  cavities,  and  disinfecting 
carious  dentine  preparatory  to  filling  teeth. 

lODOPHENACETIN. 

Derivation. — A  new  derivation  of  phenacetin  described  by 
Dr.  Scholvein,  obtained  when  a  cold-saturated  solution  of 
phenacetin,  acidulated  with  hydrochloric  acid,  is  treated  with 


ORRIS  ROOT.  409 


iodine.  It  first  forms  as  a  gray  precipitate,  which  afterwards 
appears  as  a  mass  of  crystaUine  needles  or  an  amorphous 
mass.  It  forms,  when  dry,  a  chocolate-brown  powder.  When 
recrystallized  from  glacial  acetic  acid,  it  may  be  obtained  in 
steel-blue  crystals.  By  dissolving  the  phenacetin  in  glacial 
acetic  acid  and  afterwards  diluting  with  water,  less  quantities 
of  liquid  are  required  in  its  preparation  than  would  be  the 
case  if  a  mere  aqueous  solution  of  phenacetin  was  employed. 
The  resulting  product,  called  '' iodophenin"  melts  at  130^., 
decomposing  at  the  same  time.  It  contains  one  portion  of  its 
iodine  in  a  more  intimate  combination  than  the  other.  It  is 
soluble  in  20  parts  of  cold  glacial  acetic  acid,  more  easily  in 
the  same  liquid  when  hot,  and  is  soluble  in  alcohol,  but  not 
readily  soluble  in  benzole  and  chloroform.  If  heated  with 
water,  it  is  decomposed.  It  has  a  strong  odor  of  iodine,  and 
a  burning  taste.  Ordinarily  it  contains  50.5  per  cent,  of 
iodine. 

Medical  Properties  and  Therapeutic  Uses. — lodophenacetin 
is  an  antiseptic,  and  possesses  marked  powers  as  a  bactericide  ; 
but  when  given  subcutaneously  it  produces  marked  local  irri- 
tation, and  when  given  internally  it  forms  combinations  with 
the  alkalies  of  the  intestinal  canal,  and  consequently,  from  the 
readiness  with  which  iodine  is  given  up,  iodine-poisoning  may 
readily  follow  the  administration  of  even  small  doses. 

IRIDIS  RHIZOME— ORRIS  RHIZOME— ORRIS  ROOT. 

Source. — The  plant  from  which  Orris  Root  is  obtained  is  a 
native  of  Italy  and  the  south  of  Europe.  It  belongs  to  the 
natural  order  Iridaceae,  of  which  there  are  three  varieties  of 
the  species  of  Iris — Iris  Rhisoma,  Iris  Florentina  and  Iris  Ger- 
manica.  The  root,  which  is  the  officinal  portion  of  the  plant, 
is  of  various  forms  and  sizes,  often  branched,  usually  knotty 
and  flattened,  white,  heavy,  and  of  the  thickness  of  the  finger. 
It  has  a  pleasant  odor,  like  that  of  violet,  and  a  bitter,  acrid 
taste. 

Medical  Properties  and  Action. — Orris  root  is  cathartic  and 
diuretic,  and  in   large  doses  emetic.     It  has  been  employed 


410  DENTAL   MEDICINE. 


with  some  benefit  in  dropsies,  but  is  not  often  administered  as 
a  general  remedy  at  the  present  time.  It  is  valued  for  its 
pleasant,  violet  odor. 

Dental  Uses. — In  dental  practice  it  is  employed  as  a  very 
common  ingredient  of  dentifrices,  and  also  to  correct  an 
offensive  breath, 

•       DENTAL   FORMULA. 
Dentifrice, 
Dr.  Sewell. 

Ijt .        Pulv.  radicis  iridis ^  ss 

Pulv.  saponis  cas '^\] 

Pulv.  sodii  boratis 3  ij 

Cretse  preparatse ^ij.  M. 

Flavor  with  a  few  drops  of  oil  of  cloves  and  lavender.  Or,  add 
a  few  drops  of  carbolic  acid  to  each  ounce  of  the  powder,  and  flavor 
the  whole  with  eucalyptus  oil. 

ISONANDRA   GUTTA— GUTTA   PERCHA. 

Source. — Gutta  Percha  is  the  inspissated  juice  of  the  tree 
Isonandra  Giitta,  extensive  forests  of  which  are  found  in  the 
East  Indies.  It  belongs  to  the  natural  order  Sapotaceoe.  It  is 
in  the  form  of  tough,  flexible  pieces,  which  have  been  freed 
from  impurities  by  cutting  it  into  thin  slices,  and  then  washing 
and  tearing  it  into  shreds  by  heavy  machinery  while  it  is  soft- 
ened in  boiling  water.  It  may  be  more  thoroughly  purified 
by  dissolving  it  in  either  chloroform,  benzol  or  hot  turpentine, 
thus  causing  the  impurities  to  separate,  when  it  is  evaporated 
to  dryness.  Crude  gutta  percha  is  of  a  chocolate  or  reddish- 
brown  color ;  commercial  gutta  percha  is  of  a  grayish-white 
color,  and  the  variety  which  has  been  purified  by  dissolving  it 
in  chloroform,  etc.,  is  almost  white,  greasy  to  the  touch,  and 
of  a  leathery  smell,  like  that  of  India  rubber.  It  is  insoluble 
in  water  at  any  temperature,  and  is  a  bad  conductor  of  heat 
and  electricity.  At  ordinary  temperatures  it  is  tough,  hard 
and  inelastic,  but  toward  120°  F.  it  softens,  and  at  150°  it 
becomes  soft  and  plastic,  and  may  be  moulded  into  any  form, 
which  it  will  retain  on  cooling,  having,  however,  a  perceptible 
shrinkage.     Gutta  percha  is  dissolved  cold  by  chloroform  and 


KANDOL.  411 

sulphide  of  carbon  ;  benzol  requires  the  aid  of  heat,  and  oil 
of  turpentine  requires  to  be  quite  hot.  The  alkalies  have  no 
action  upon  it ;  but  concentrated  nitric  acid  attacks  it  rapidly, 
with  effervescence  and  the  escape  of  nitrous  fumes. 

Deiital  Uses. — Combined  with  mineral  substances  it  forms  a 
plastic  material  for  temporary  fillings  of  teeth,  and,  colored 
with  vermilion,  is  used  for  taking  impressions  of  the  mouth 
and  for  the  base  plates  of  plastic  work.  It  is  often  employed 
as  a  filling  material,  on  account  of  its  non-conducting  prop- 
erty, protecting  a  partially  exposed  pulp  or  sensitive  dentine 
surface  from  irritation  when  metallic  fillings  would  not  be  tol- 
erated. Gutta  percha  has  also  been  used  for  interdental 
splints. 

The  preparation  known  as  "  Hill's  Stopping"  is  composed 
of  gutta  percha,  quicklime  and  feldspar,  the  mineral  ingredi- 
ents being  incorporated  with  the  gutta  percha  while  the  latter 
is  in  a  plastic  condition  from  the  effects  of  heat. 

Solution  of  Gutta  Percha — Liquor  Gutta  Percha,  Chloro- 
percha,  is  composed  of  gutta  percha,  Siss ;  chloroform,  Sxvij ; 
or  a  thick  solution  may  be  made  by  dissolving  as  much  gutta 
percha  in  chloroform  as  will  give  the  desired  consistence  (like 
that  of  thick  cream). 

Solution  of  gutta  percha  is  a  useful  application  for  the  relief 
of  odontalgia  arising  from  an  exposed  and  inflamed  pulp  ;  also 
for  capping  an  exposed  pulp,  a  more  durable  material  being 
inserted  over  it.  The  chloroform  of  the  solution  quickly 
evaporates,  leaving  an  impermeable  covering  of  the  gutta 
percha,  which  is  non-irritable,  non-conducting  and  protective. 
It  is  also  a  useful  application  for  inflamed  or  abraded  surfaces, 
chaps,  skin  affections,  etc.  Gutta  percha  dissolved  in  chloro- 
form is  a  popular  and  efficient  material  for  root  fillings,  as  are 
also  cones  of  gutta  percha  softened  by  heat  or  in  chloroform. 

KANDOL. 

Kandol  is  a  product  formed  by  the  distillation  of  naphtha, 
and  is  a  perfectly  clear,  colorless  fluid,  extremely  volatile, 
burns  easily,  and  has  a  slight  odor  of  benzine.     It  can  be  mixed 


412  DENTAL  MEDICINE. 


with  a  small  quantity  of  water  or  alcohol,  and  its  preparation 
is  cheap  and  simple.  Dr.  Njuschkon  advocates  the  use  of 
kandol  in  the  place  of  ether  or  cocaine  as  a  local  anaesthetic 
in  the  form  of  spray.  In  one  minute  kandol  will  reduce  the 
temperature  to  io°  C,  and  keep  it  nearly  uniform  at  that  tem- 
perature for  some  time,  while  ether  reduces  the  temperature 
to  17°  C.  As  an  effect  of  the  spray  of  kandol,  the  skin  be- 
comes very  hard  and  is  completely  anaesthetized,  and  there  is 
no  bleeding,  or  else  the  blood  coagulates  as  soon  as  it  makes 
its  appearance,  so  that  all  operations  may  be  performed  with 

ease  and  rapidity. 

KRAMERIA. 

RHATANY. 

Source. — Krameria  is  obtained  from  the  root  of  the  shrub 
krameria  triandra,  of  the  natural  order  Polygalece,  native  of 
Peru.  It  is  in  the  form  of  cylindrical  pieces,  of  the  thickness 
of  a  quill,  with  many  branches  of  a  light  red  color  within  and 
crossed  by  a  reddish-brown  bark.  The  root  is  without  odor, 
and  of  an  astringent  and  somewhat  bitter-sweetish  taste. 

Medical  Properties  and  Action. — Krameria  is  a  powerful 
astringent,  its  medicinal  property  being  due  to  tannic  acid,  of 
which  it  contains  about  forty  per  cent.  There  is  also  present 
an  odorous  principle,  wax  gum,  and  a  peculiar  acid  known  as 
krameric  acid.  When  chewed  it  imparts  a  red  tinge  to  the 
saliva.  It  imparts  its  properties  very  readily  to  alcohol,  but 
less  so  to  both  cold  and  boiling  water. 

Therapeutic  Uses. — Krameria  is  employed  internally  for  its 
astringent  and  a  slightly  tonic  effect  in  the  treatment  of  diar- 
rhoea, dysentery,  passive  hemorrhages,  menorrhagia,  leucor- 
rhoea,  etc.  Externally,  in  the  form  of  powder,  tincture  and 
infusion,  in  the  treatment  of  ozaena,  ophthalmia,  etc.,  and  as 
an  enema  in  hemorrhoids,  fissures  of  the  anus,  sore  nipples, 
leucorrhoea,  etc.,  etc. 

Dose. — Of  powdered  krameria,  gr.  xx  to  gr.  xxx ;  of  the 
extract — extraction  kramericE,  the  dose  is  gr.  v  to  gr.  x;  of 
the  infusion — infusum  krameria — (kramerise  Sj;  water,  Oj), 
the   dose   is  .^ss  to  oj ;  of  the   tincture — tinctura  kramericE — 


KRESOLUM.  413 


(kramerise,  5vj;  diluted  alcohol,  Oij),  the  dose  is  5j  to  5ij. 
Of  the  fluid  extract — extractiivi  kramericE  fluidum,  the  dose  is 
TTL  V  to  5ss;  of  the  syrup — syriipus  kramericE,  the  dose  is  5j 
to  5iv. 

Dental  Uses. — Krameria  is  a  valuable  astringent  in  dental 
practice,  being  employed  in  the  form  of  the  tincture,  in  ulcer- 
ated and  spongy  gums ;  in  the  form  of  the  infusion,  as  a 
gargle  in  inflammation  of  the  gums  and  mucous  membrane; 
in  the  form  of  the  powder  and  also  tincture,  in  spongy  and 
bleeding  gums,  as  an  astringent;  and  also  in  the  form  of  the 
powder  as  an  ingredient  of  dentifrices,  for  its  astringent 
property. 

DENTAL   FORMULA. 


Astringent  and  Stimulant  Mouth- 

For  Gingivitis. 

Wash. 

R.    Tr.  kramerise, 

Dr.  Sabatir. 

Boro-glyceride, 

R. 

Tr.  kramerise  .    .    .    .   ^j 

Eau  de  cologne  .    ,  aa  ^  j 

Tr.  opii 5ij 

Spts.  villi  rect.  .    .  ad  ^viij.     M. 

Tr.  myrrhse     .    .    .    .   5J 

SiGNA. — A  teaspoonful  to  be  added  to 

Aquse  camph.     .    .    .   5vj. 

a  little  water. 

SiGNA. — Use  as  a  mouth  wash. 

For    Inflamed    Gums    and  Mucous 

Membrane. 

Styptic  for  Bleeding  Gums. 

Thomas. 

R  .    Pulv.  kramerice, 

VlAU, 

Pulv.  cinnamomi  .  aa    ^j 

R. 

Tincturse  kramerise    .  f3J 

Aqute  bullientis     .    •  f^vii 

Chloroformi     ....  gr.6o 

Macerate  for  2  hours,  strain,  and  add 

Acidi  tannici  ....  grs.xxx 

sacchari  ^ij. 

Menthol grs.xxx 

SiGNA. — To  be  used  as  a  gargle. 

Aquse  destillatje .    .    .  f5xvij. 

KRESOLUM. 

M. 


M. 


Formula.— C,Y{^.C.Y{^.Oli+B.^O. 

Kresolum  purum  liquefactum  is  an  antiseptic  introduced  by 
H.  Nordlinger  as  a  substitute  for  trikesole,  having  the  max- 
imum amount  of  water  which  it  will  hold  in  solution.  Dis- 
solved in  water,  a  two  and  one-half  per  cent,  solution  can  be 
prepared  readily  by  shaking.  Kresolum  is  said  to  have 
three-fold  the  antiseptic  power  of  carbolic  acid,  and  hence  a 


414  DENTAL   MEDICINE. 


one  per  cent,  solution  is  equal  to  a  three  per  cent,  carbolic- 
acid  solution. 

LANOLIN. 

Lanolin  is  the  natural  fat  of  wool,  and  is  used  as  a  substitute 
for  ordinary  fat  for  local  use.  On  account  of  its  being  analogous 
to  the  natural  fat  of  the  skin,  it  is  supposed  to  be  more  freely 
absorbed  by  the  tissues  than  the  ordinary  fats;  hence  it  is 
employed  as  a  vehicle  for  remedies  which  are  to  be  absorbed, 
and  for  such  a  purpose  has  been  combined  with  arsenious  acid 
and  hydrochlorate  of  cocaine  in  a  devitalizing  mixture. 

DENTAL  FORMULA. 
For  Soft,   White  Hands. 

R .        Lanolin 20  parts 

Glycerine 20  parts 

Borate  of  soda 10  parts 

Oil  of  eucalyptus 2  parts 

Essence  of  bitter  almonds 25  drops.    M. 

SiGNA. — Rub  hands  with  preparation,  and  cover  with  gloves  at  night. 

LIQUOR  SOD^  CHLORAT^E -SOLUTION  OF  CHLORINATED  SODA. 
LABARRAQUE'S  SOLUTION. 

Formula. — NaCl,  NaClO. 

Derivation. — Solution  of  Chlorinated  Soda  is  obtained  by 
decomposing  a  solution  of  carbonate  of  sodium  by  one  of 
chlorinated  lime.  It  is  a  transparent  liquid,  of  a  greenish- 
yellow  color,  having  a  faint  odor  of  chlorine  and  a  sharp 
saline  taste. 

Medical  Properties  and  Action. — Solution  of  chlorinated  soda 
internally  is  stimulant,  tonic  and  antiseptic.  Externally  it  is 
a  stimulant,  astringent  and  deodorizer,  and  is  generally  applied 
in  the  form  of  a  lotion. 

Therapeutic  Uses. — Solution  of  chlorinated  soda  is  employed 
internally  in  typhus  and  typhoid  and  malignant  scarlet  fevers, 
mesenteric  affections  of  children,  etc.  Externally  it  is  used 
as  an  appHcation  to  all  forms  of  foul  and  indolent  ulcers,  ulcera- 
tions of  membrane,  ozasna,  coryza,  otorrhoea,  syphilitic  erup- 
tions of  scalp  and  other  skin  diseases,  burns,  etc.,  etc.    It  is  used 


KINO.  415 

diluted,  and  has  an  alkaline  reaction.  It  is  a  powerful  disinfec- 
tant, and  is  useful  in  all  affections  attended  with  fetor.  The 
concentrated  solution  is  an  irritant  poison  and  caustic  ;  largely- 
diluted  it  is  tonic  and  stimulant. 

Dose. — A  solution  of  chlorinated  soda,  gtt.  xxx  to  5j,  diluted, 
several  times  a  day ;  it  fulfills  the  same  indications  as  chlor- 
inated lime. 

Dental  Uses. — Solution  of  chlorinated  soda  is  a  valuable 
agent  in  dental  practice  as  a  disinfectant,  deodorizer  and  anti- 
septic. It  is  employed  in  mercurial  stomatitis,  ulcerated  gums, 
fetid  discharges  from  carious  teeth,  and  all  affections  of  the 
mouth  attended  with  fetid  discharge,  and  is  useful  for  its  stim- 
ulating property,  thus  inducing  healthy  action  ;  also  m  aphthae, 
cancrum  oris,  diseases  of  the  antrum,  necrosis  of  the  bones  of 
the  jaws,  scurvy,  offensive  breath,  and  as  a  bleaching  agent  for 
discolored  teeth,  especially  in  combination  with  powdered  alum. 
It  should  be  kept  in  glass-stoppered  bottles  and  protected  from 
the  light  and  heat. 

DENTAL   FORMULA. 

For  Aphtha  and  Ulceration  of  the      For  Mercurial  Stomatitis,  Fetid  Dis- 

Mouth  of  Children.  charges  from   Carious   Teeth,    Ulcer- 

R.    Liquor  sodse  chlor.,  ated  Gums,  etc. 

Myrrhse aaf^ss  R.    Liquor  sodas  chlor.    .  f^vj 

Aquae  rosse f^j  AquK fS'^'J-     ^• 

Aquae fS^j-  M.       SiGNA. — To  be  used  as  a  lotion. 

SiGNA. — To  be  used  as  a  lotion.  ,   t^     ,     ■ 

For  Offensive  Breath  and  Deodoriser 

For  Mercurial  Stomatitis.  Generally. 

R .    Liquor  sodse  chlor.    .  f  ss  g  _    Liquor      sodee     chlor. 

Mellis gss  (concent.)    ....   gtt.vj  to  x 

Aquffi  destillatse  .    .    .  ,fx.         M.  Aquce  purse     .    .    .    .   5ij.         M. 

SiGNA. — To  be  used  as  a  mouth-wash.  SiGNA. — To  be  used  as  a  gargle. 

For  Phagedenic  and  Sloughing  Ulcers.  For   Offensive  Breath. 

R.    Liquor  sodse  chlor.    .  f^j  R.    Liquor  sodse  chlor.    .  J^j 

Aqute f^viij.    M.  Aqun; 3iv.        M. 

SiGNA. — To  be  applied  as  a  lotion.  Signa. — To  be  used  as  a  gargle. 

KINO— KINO. 
Source. — The  inspissated  juice  of  the  Pterocarpus  Marsupium, 
and  of  other  plants. 


416  DENTAL   MEDICINE. 


Medical  Properties  and  Therapeutic  Uses. — With  Krameria, 
Galla,  and  Catechu,  Kino  is  one  of  the  substances  containing 
forms  of  tannic  acid,  and  has  the  same  physiological  action 
and  uses,  being  powerfully  astringent.  The  tincture,  "  Tijtc- 
titrcE  Kino"  compound  of  ten  parts  of  kino  to  one  hundred 
parts  of  alcohol,  is  the  only  preparation  employed. 

Dose. — Of  TincturcB  Kino,  itL^  to  oij.  (See  Tannic  and 
Gallic  Acids,  Krameria.) 

LITHIUM— LITHIUM. 

Source. — From  the  alkali  Lithium,  which  is  rare  in  nature. 

Preparations. — Litliii  Carbonas — carbonate  of  lithium,  a  white 
powder  but  slightly  soluble  in  water,  and  having  a  feeble  alka- 
line reaction. 

Dose. — Grs.  ij  to  grs.  x. 

Lithii  Citras. — Citrate  of  Lithium,  a  deliquescent  white  pow- 
der, soluble  in  twenty-five  parts  of  water. 

Dose. — Grs.  v  to  grs.  xxx. 

Lithii  Salicylas. — Salicylate  of  Lithium,  a  deliquescent  white 
powder  with  a  sweetish  taste,  feeble  acid  reaction  and  very 
soluble  in  alcohol  and  water. 

Dose. — Gr.  v  to  3j. 

Litliii  Benzoas. — Benzoate  of  Lithium,  either  in  the  form  of 
a  white  powder  or  small,  shining  scales,  not  deliquescent  in 
the  air,  and  having  a  sweetish,  cooling  taste  and  a  feeble  acid 
reaction. 

It  is  soluble  in  twelve  parts  of  alcohol  at  60°  F.,  and  in  four 
parts  of  water. 

Dose. — Gr.  ij  to  gr.  xv. 

Medical  Properties  ajid  Therapeutic  Uses.  —  These  lithium 
salts  have  strong  alkaline  properties,  and  produce  effects  sim- 
ilar to  those  of  the  potassium  and  sodium  compounds ;  and 
hence  are  very  effective  antacid  agents.  The  salts  of  lithium 
are  employed  with  great  benefit  in  rheumatic  gout,  uric  acid 
diathesis,  rheumatism,  uric  acid  calculi  of  kidneys  and  blad- 
der, irritable  bladder  from  an  excess  of  acid  in  the  urine,  etc. 


LITMUS.  417 

Dental  Uses. — The  lithium  salts  are  effective  in  preventing 
and  correcting  the  effects  of  a  gouty  diathesis  upon  the  teeth, 
and  in  periodontitis  dependent  upon  gout.  The  carbonate  of 
lithium  is  employed  to  arrest  the  abrasion  or  erosion  of  the 
teeth,  when  due  to  an  excess  of  uric  acid  in  the  saliva;  for 
such  a  purpose  the  agent  can  be  dissolved  in  carbonic  acid 
water. 

LITMUS— LACMUS. 

Sow'ce. — Litmus  is  a  peculiar  coloring  matter  obtained  from 
various  species  of  rocella,  of  the  natural  order  Lichenes — the 
Lichen  order,  which  grow  on  Alpine  or  maritime  rocks  in 
various  parts  of  the  world.  The  varieties  used  for  chemical 
purposes  are  obtained  from  the  European  and  African  coasts 
and  Northern  Europe.  They  yield  coloring  substances  by 
the  reaction  of  water,  air,  and  ammonia.  Litmus  is  prepared 
chiefly  in  Holland ;  the  lichens  being  coarsely  powdered  and 
macerated  for  several  weeks,  with  occasional  agitation  in  a 
mixture  of  urine,  lime  and  potassa  or  soda,  fermentation  en- 
suing ;  the  mass  becomes  first  red  and  ultimately  blue,  and  is 
then  mixed  with  calcareous  or  siliceous  matter,  to  give  it  con- 
sistence. A  tincture  is  formed  from  this  product  (litmus  i  part 
to  distilled  water  20  parts),  and  blue  litmus  paper  is  made  by 
steeping  unsized  paper  in  the  liquid  and  afterwards  drying  it. 
The  blue  tincture  is  rendered  deeper  in  color  by  indigo.  Red 
litmus  paper  is  prepared  in  the  same  manner,  except  that  the 
tincture,  into  which  the  unsized  paper  is  steeped,  is  reddened 
by  the  addition  of  the  sulphuric  acid. 

Dose. — The  chief  use  of  litmus  in  medicine  and  dentistry  is 
as  a  test  of  acids  and  alkalies ;  bhie  litmus  paper  being  turned 
red  by  acids,  while  red  litmus  paper  is  turned  blue  by  alkalies. 
In  dental  practice  litmus  paper  is  employed  to  determine  the 
nature  of  the  oral  fluids — -whether  acid  or  alkaline. 

A  single  color,  viz.,  purple,  has  recently  been  substituted 
for  the  ordinary  blue  and  red  litmus  paper.  This  purple 
litmus  paper  turns  red  with  acids,  blue  with  alkalies.  It  is 
claimed  to  be  much  more  delicate  and  convenient. 

27 


418  DENTAL   MEDICINE. 


LORETIN— META-IODO-ORTHO-OXYQUINOLINE   AND   SUL- 
PHONIC   ACID. 

Loretin  is  a  new  succedanum  for  iodoform,  and  is  in  the 
form  of  a  beautiful  yellow  crystalline  powder,  which  resembles 
iodoform  in  appearance,  but  is  free  from  objectionable  odor, 
and  does  not  produce  an  artificial  eczema,  two  drawbacks  to 
the  use  of  iodoform,  as  loretin  is  completely  odorless. 

In  water  and  alcohol,  loretin  is  only  slightly  soluble,  in 
ether  and  oils  practically  insoluble,  but  with  oily  liquids  and 
especially  with  collodion,  it  forms  emulsions  which  are  excel- 
lently adapted  for  many  purposes. 

Therapeutic  Uses. — Loretin  is  non-poisonous,  and  is  equally 
well  adapted,  especially  when  mixed  with  a  small  proportion 
of  calcined  magnesia,  as  a  dusting  powder  for  the  surface  of 
wounds  and  for  insufflating  into  hollows  and  cavities.  Bacte- 
riological experiments  by  Ammelburg,  have  demonstrated  the 
power  of  loretin  as  a  germicide  as  well  as  an  antiseptic. 

In  the  treatment  of  wounds,  the  surface  is  kept  clean  with 
dry  sterilized  pads  of  gauze,  and  then  closed  with  the  needle, 
A  bandage  with  lumps  of  surgical  wadding  and  loretin 
collodion  is  then  laid  upon  the  closed  wound.  Cavities  are 
dusted  with  loretin  powder,  or  a  tampon  of  loretin  gauze 
is  introduced ;  a  small  pencil  of  loretin  is  laid  in  punctured 
wounds. 

The  healing  of  the  wounds  is  usually  unaccompanied  by  any 
fever  and  progresses  without  festering.  There  is  an  absence 
of  any  irritating  effect  on  the  skin,  and  persistent  eczema  has 
been  cured  by  this  agent;  it  is  also  employed  in  empyema  of 
the  pleural  cavity  and  purulent  cystitis. 

Dental  Uses. — In  dental  practice  loretin  may  be  employed 
in  all  cases  requiring  the  application  of  antiseptics  and  germi- 
cides, as  a  substitute  for  iodoform  (for  the  dental  uses  of  which 
see  page  396)  and  without  the  disadvantages  of  the  latter  agent. 

LYSOL. 
Derivation. — Lysol  is  obtained  by  boiling  scoal  tar  with  fat, 
alkali,  resinous  acid  and  resin,  and  contains  no  phenol,  but 


LYSOL.  419 

principally  cresol.  It  is  readily  soluble  in  water,  and  has  a 
strong  pungent  odor.  It  is  of  the  consistence  of  soft  or  pot- 
ash soap,  or  in  the  form  of  a  clear  oily  liquid. 

Lysol  is  a  very  complex  substance  (not  homogeneous),  with- 
out any  definite  formula. 

Medical  Properties  and  TJierapeittlc  Uses. — It  is  claimed  that 
lysol  is  superior  as  a  germicide  to  corrosive  sublimate,  car- 
bolic acid,  iodoform,  and  creolin,  its  bactericide  properties 
being  very  great.  As  an  antiseptic,  etc.,  in  the  treatment  of 
wounds  a  i  per  cent,  solution  is  employed ;  for  internal  wash- 
ings y^  per  cent,  solutions  are  recommended.  It  sometimes 
exerts  an  irritant  action  on  the  skin. 

Dr.  F.  Haenel  lays  special  stress  upon  the  simplicity  of  its 
use — a  few  minutes'  energ-etic  brushing  with  the  solution  being 
all  that  is  required  to  prepare  a  surface  for  operation,  instead 
of  the  usually  complicated  process  of  cleaning  and  disinfection 
of  the  skin.  For  this  purpose  Lysol  answers  as  well  as  the 
best  soap,  removing  not  only  visible  dirt,  but  fatty  or  resinous 
spots  on  the  skin,  instruments,  etc.  The  soapy  feeling  it 
imparts  to  the  hands,  instruments  and  sutures,  is  best  avoided 
by  drying  the  hands  and  the  prepared  area  of  operation  with 
a  sterilized  cloth  before  beginning  to  operate. 

With  respect  to  the  bactericidal  properties  of  the  prepara- 
tion Schotellius  found  that  in  15  to  20  minutes  a  one-third  per 
cent,  solution  destro}'ed  all  kinds  of  germs.  The  investiga- 
tions of  Gerlach  led  to  similar  results,  and  the  experiences  of 
Dr.  F.  Haenel  are  also  in  accordance  with  these  statements. 
He  used  solutions  varying  in  strength  from  /^  to  ^  per 
cent.,  and  on  all  grounds  concludes  that  Lysol  is  superior  to 
sublimate,  carbolic  acid,  iodoform,  and  the  other  ordinary  an- 
tiseptics, either  by  virtue  of  its  non-poisonousness,  or  odor- 
lessness,  or  the  clearness  of  its  solutions.  It  forms,  he  points 
out,  clear  mixtures  with  distilled  water,  or  with  ordinar}'  water 
which  does  not  contain  much  chalk.  In  solutions  made  with 
spring  or  tap  water  which  contains  much  lime,  a  turbidity 
appears  which  increases  in  the  progress  of  time,  and  is  less 
conspicuous  in  strong  than  in  weak  solutions.     As  the  disin- 


420  '  DENTAL  MEDICINE. 


fectant  constituents  remain  in  solution,  the  bactericidal  action 
of  the  liquid  is  in  no  way  prejudiced.  For  some  purposes 
this  turbidity  is  a  disadvantage,  however,  and  the  author  states 
that  the  best  way  to  avoid  it,  is  to  prepare  the  solutions  imme- 
diately before  use,  if  necessary,  to  avoid  the  employment  of 
the  weaker  dilutions. 

Dental  Uses. — Lysol  may  be  employed  in  dental  practice  as 
an  antiseptic,  disinfectant,  and  germicide  in  the  case  of  putre- 
scent or  gangrenous  pulps,  to  disinfect  root-canals,  and  carious 
cavities  of  teeth  ;  also  in  the  form  of  a  i  per  cent,  solution  for 
unhealthy  wounds  and  ulcers  of  the  oral  mucous  membrane, 
upon  which  it  has  an  astringent  effect.  It  is  advisable  to  em- 
ploy lysol  in  from  ^  to  i  per  cent,  solution  whenever  an  an- 
tiseptic or  aseptic  operation  is  desired. 

DENTAL  FORMULAE. 
Mouih   Wash. 

R.        Lysol ^ss 

Aquse ^xvj.  M. 

For  Alveolar  Pyorrhcea. 
Dr.  F.  T.  Van  Woert. 

R ,        Lysol f  g  ij 

Tinct.   capsicum gtt.xv 

Tinct.  iodine f^j.  M. 

SiGNA. — Five  drops  in  one-half  glass  of  water  used  as  a  wash  in 
cleansing  teeth  with  a  brush. 

»     MAGNESIA— CALCINED  MAGNESIA. 

Fovrmda. — MgO. 

Derivation. — Magnesia  is  obtained  by  exposing  carbonate  of 
magnesium  to  a  red  heat,  and  thus  expelling  all  of  the  car- 
bonic acid,  which  is  shown  by  a  want  of  effervescence  on  the 
addition  of  dilute  sulphuric  acid.  It  is  very  light,  and  of  white 
color  and  odorless,  and  in  the  form  of  powder,  with  an  earthy 
taste,  and  slightly  soluble  in  water,  more  so  in  cold  than  in 
hot  water. 

Medical  Properties  and  Action. — Magnesia  is  antacid  and 
laxative,  its  laxative  effect  being  the  result  of  the  combination 
it  forms  with  the  free  acids  of  the  stomach  and  intestines. 


CALCINED   MAGNESIA.  421 


After  its  effects  are  exerted  in  the  intestinal  canal,  it  becomes 
absorbed  and  renders  the  urine  alkaline.  Large  doses,  when 
administered  for  a  considerable  time,  may  accumulate  in  the 
bowels ;  such  an  effect  may  be  avoided  by  administering  it 
with  lemonade,  which  renders  it  more  soluble.  Being  mild 
and  unirritating,  it  is  well  adapted  for  children,  and  is  an  ex- 
cellent remedy  for  great  acidity  in  the  stomach.  It  is  the 
antidote  for  poisoning  by  the  mineral  acids. 

Therapeutic  Uses. — Magnesia  is  administered  in  acidity  of 
the  stomach,  heartburn,  sick  headache  and  kidney  affections, 
as  an  antacid,  and  in  combination  with  other  agents  in  the 
diarrhoea  of  children.  It  is  also  an  efficient  aperient,  alone  or 
in  a  little  milk. 

Dose. — Of  magnesia,  as  a  laxative,  gr.  x  to  5j ;  as  an  ant- 
acid, 3j.  Of  a  preparation  known  as  "  Henry's,"  the  dose  is 
half  the  quantity  just  given. 

Dental  Uses. — Magnesia  is  employed  in  dental  practice, 
chiefly  for  its  antacid  properties,  as  an  ingredient  of  dentifrices  ; 
in  solution  in  the  form  of  a  gargle,  to  counteract  the  effect  of 
acid  medicines  upon  the  teeth  ;  also  as  an  ingredient  of  reme- 
dies for  infantile  diarrhoea  during  the  period  of  dentition  ;  and 
also  to  change  an  acid  condition  of  the  oral  fluids,  by  being 
rubbed  between  the  teeth  and  permitted  to  remain  for  a  short 
time. 

Magnesium  Hydrate. — Dr.  E.  C.  Kirk  recommends  Phillips' 
Milk  of  Magnesia,  which  consists  of  precipitated  magnesium 
hydrate  held  in  suspension  in  water,  for  counteracting  the 
injurious  action  of  acid  secretions,  especially  in  erosion  cases. 
It  is  applied  in  the  same  wa)^  that  lime-water  or  precipitated 
chalk  is  used  for  the  purpose  of  bringing  about  an  alkaline 
condition  of  the  oral  fluids,  by  neutralizing  the  excess  of  acids 
present.  A  teaspoonful  of  the  preparation  taken  into  the 
mouth  and  allowed  to  float  around  over  the  teeth  coats  them 
with  a  slight  film  of  magnesium  hydrate,  which  protects  the 
tooth-surface  from  the  acid  action  for  a  number  of  hours.  It 
should  be  used  three  times  daily,  after  meals,  and  for  erosion, 
night  and  morning. 


422  DENTAL   MEDICINE. 


DENTAL  FORMULA. 
For  Infantile  Bilious  Diarrhoea,  For  Infantile  Mucous  Diarrhoea. 

CONDIE.  .  .     E«^^^^- 

R .    Magnesia  calc.  ,    .    .  gr.x 
R.    Magnesise  calc.  .    .    .  gr.xxjv  Bals.  copaibte .    .    .    .  3J 

Calomel gr-ij-iij  Spir.  sether  nit.   .    .    .  ^iij 

Ipecacuanha   ....  gr.ij-iij  Sacch.  alb jij 

Ext.  hyoscyami  .    .    .  gr.iv-vj.  M.  A q.  cinnamon .    .    .    .  ^iij.       M. 

r.  en.  No.  xij.  Signa. —  A   teaspoonful   every   2   or  3 

SiGNA. — One  tcbe  given  every  2  or  3  hours;  each  dose  to  be  followed  in 

liQ^j-g^  the  course  of  an  hour  by  the  fifth  of 

a  grain  of  Dover's  Powder. 

MAGNESII   SULPHAS— SULPHATE   OF   MAGNESIUM. 
(EPSOM  SALT.) 

Formula.— M.^'^O^jYi^O. 

Derivation. — Epsom  Salt  is  obtained  by  the  action  of  sul- 
phuric acid  on  inagnesite,  the  siliceous  hydrate  of  magnesium. 
It  is  in  the  form  of  small,  colorless  crystals,  which  effloresce 
on  exposure  to  the  air,  and  are  very  soluble  in  water.  It  is 
odorless,  but  has  a  very  bitter  taste. 

Medical  Pi^operties  and  Action. — Sulphate  of  magnesia  is  a 
refrigerant  purgative,  safe  and  mild  in  its  action,  and  is  per- 
haps more  commonly  employed  as  a  cathartic  than  any  other. 
It  is  at  times  combined  with  other  agents. 

Therapeutic  Uses. — Sulphate  of  magnesia  is  administered  as 
a  saline  purgative  in  acute  inflammatory  and  febrile  affections, 
to  depress  the  arterial  tension,  and  also  to  relieve,the  kidneys 
where  they  are  hyperaemic ;  hence  it  is  a  valuable  remedy  in 
renal  and  cardiac  dropsy,  constipation  of  lead  colic,  acute 
dysentery,  dyspepsia  with  constipation,  etc.,  etc. 

Dose. — Of  sulphate  of  magnesia,  5j  to  Sj,  in  water  or  car- 
bonic acid  water. 

Dental  Uses. — Sulphate  of  magnesia  is  employed  internally 
in  dental  practice,  to  reduce  the  arterial  tension  in  acute 
inflammations  'of  the  dental  organs,  such  as  acute  pulpitis, 
acute  periodontitis,  etc. 

To  disguise  the  bitter  taste  of  Epsom  salts,  the  following 
formula  may  be  employed  : — 


MATICO.  423 

R .        Magnesii  sulphatis ^v 

Essentise  menthae gtt.iij.  M. 

DENTAL    FORMULA. 
I^or  Dysuria  of  Difficult  Dentition. 

R .        Sulph.  magnes g  ij  to  ,^5  iij 

Aquffi  purse ^j  dein  adde 

Spir.   aether,  nitrici ^ij 

Tinct.  opii TTLvij  to  xv.    M. 

SiGNA. — A  teaspoonful,  to  be  repeated  according  to  circumstances. 

MATICO. 

Source. — Matico — maticcs  folics — are  the  dried  leaves  of  the 
shrub  artanthe  elongata,  of  the  natural  order  PiperacecB — pep- 
per order,  and  is  a  native  of  Peru.  They  are  from  two  to 
eight  inches  long  by  an  inch  in  breadth,  strongly  reticulated, 
and  of  a  bright  green  on  the  upper  surface  and  lighter  in  color 
beneath  when  fresh,  with  an  agreeable  aromatic  odor  and  a 
strong  astringent  taste.  They  contain  a  trace  of  tannic  acid, 
a  peculiar  acid,  artanthic,  a  volatile  oil,  resin,  and  a  very  bitter 
principle — maticin. 

Medical  Properties  and  Action. — Matico  is  an  aromatic  tonic, 
an  alterative  stimulant,  an  internal  haemostatic  and  local  styp- 
tic. It  has  a  special  determination  to  the  mucous  membranes, 
and  although  as  an  internal  remedy  its  astringent  properties 
are  not  so  well  marked,  it  acts  externally  as  a  reliable 
heemostatic  and  styptic.  The  powder  made  from  the  under 
side  of  the  leaf  is  more  powerfully  styptic  than  that  from  the 
upper  side. 

Therapeutic  Uses. — Matico  in  the  form  of  powder,  infusion 
and  fluid  extract,  is  employed  in  internal  hseniorrhages,  epis- 
taxis,  atonic  diarrhoea  and  diseases  of  the  urinary  passages, 
etc.;  externally  as  a  haemostatic  in  superficial  haemorrhages, 
and  also  in  leucorrhcea,  in  the  form  of  an  injection. 

Dose. — Of  powdered  matico,  5ss  to  3j,  three  times  a  day; 
of  the  infusion  the  dose  is  f.jij  ;  of  the  fluid  extract  the  dose 
is  f5ss  to  foj. 

Dental  Uses. — The  powder  and  tincture  are  valuable  styp- 
tics in  hemorrhage   following  the  extraction  of  teeth,  hemor- 


424  DENTAL   MEDICINE. 


rhage   from    leech   bites  and    superficial  wounds  of  mucous 
membrane. 

MENTHOL— JAPANESE  CAMPHOR, 
(PEPPERMINT  CAMPHOR.) 

Formula. — C10H20O. 

Derivation. — Menthol  is  the  stearoptene  of  pepperment  oil, 
and  is  obtained  from  this  oil  either  by  long  keeping  or  by- 
being  cooled  at  a  low  temperature.  Chemically,  menthol 
occupies  the  position  of  an  alcohol,  having  in  its  composition 
four  atoms  more  of  hydrogen  than  the  ordinary  camphor,  and 
containing  the  radical  menthyl.  It  is  in  the  form  of  a  crystal- 
line solid,  composed  of  small  white  crystals  of  a  peppermint 
odor  and  resembling  sulphate  of  magnesia.  It  is  imported  as 
Japanese  camphor,  its  chief  source  being  the  Japanese  and 
Chinese  peppermint  oils.  In  a  liquid  state  it  has  a  specific 
gravity  less  than  that  of  water.  It  is  rendered  liquid  and 
volatile  at  a  temperature  one  or  two  degrees  below  that  of  the 
body.  It  is  sparingly  soluble  in  cold  water,  liquefying  slowly 
in  water  at  82°  F.,  quickly  at  120°  F.,  but  remains  mostly  as 
a  separate  body.  It  is  freely  soluble  in  alcohol,  ether,  gly- 
cerine, and  in  the  fixed  and  volatile  oils. 

Medical  Properties  and  Action. — Menthol  is  anodyne,  anti- 
spasmodic, and  antiseptic.  In  doses  of  gr.  tV  to  i  it  steadies 
the  contractions  of  an  excited  heart,  and  causes  tranquillity, 
and  at  the  same  time  slight  cerebral  drowsiness. 

Half  a  grain  may  cause  vomiting  from  gastric  irritation, 
hence  care  should  be  observed  in  its  administration,  either 
internally  or  externally  about  the  mouth.  Its  internal  use  is 
not  advocated,  unless  well  diluted,  but  its  principal  use  is  as 
an  external  application. 

Therapeutic  Uses. — Menthol  is  said  to  prove  as  effectual  as 
aconite,  veratria  and  atropine  for  such  diseases  as  neuralgia, 
brachalgia  and  gout ;  more  so  it  is  claimed  by  some.  It  is 
also  used  in  chronic  rheumatism  and  in  headache.  It  is  also 
applied  to  putrefactive  wounds,  as  an  antiseptic. 

Deittal  Uses. — In  dental  practice,  menthol  has  given  satis- 
faction as  an  external  remedy  in  facial  neuralgia,   odontalgia. 


BICHLORIDE   OF   METHYLENE.  425 

as  an  obtunder  of  sensitive  dentine,  and  as  a  local  anaesthetic. 
For  relieving  the  pain  of  sensitive  dentine,  a  small  portion  of 
the  crystals  is  applied  to  the  sensitive  surface,  and  in  a  few 
minutes  the  local  anaesthetic  effect  is  produced.  As  an  anti- 
septic it  has  been  employed  in  the  treatment  of  decomposing 
pulps  of  teeth,  necrosed  teeth,  etc.  When  applied  to  mucous 
surfaces  for  its  anaesthetic  effect,  a  twenty  to  thirty  per  cent. 
solution  is  used,  but  it  is  more  evanescent  than  cocaine. 
Menthol  also  forms  an  ingredient  of  a  devitalizing  mixture. 

The  oil  of  the  ordinary  peppermint  is  considered  to  be  a 
germicide  and  antiseptic  of  considerable  power  and  rapidity. 
It  is  readily  diffusible,  does  not  evaporate  quickly,  and  is  non- 
poisonous.  It  is  useful  in  root  canals  and  fistulous  tracts  after 
removal  of  pulps,  and  for  hypersensitive  dentine. 

DENTAL  FORBIUL^. 

For  Facial  Neuralgia  and  Odontalgia.  For  Odontalgia. 

R.    Menthol gr.j  R.    Menthol gr.xv 

Spts.  vini  rectificati    .  tllj  Cocaine  hydrochlorat.   gr.xv 

Olei  eafyophylli    .    .  TTLx.        M.  Pulv.  opii ^j 

SiGNA. — For   facial    neuralgia,  painted  Mucilag.  acacise, 

on  the  affected  part.    For  odontalgia,  Pulv.  altheas  .    .    .  aa  q.  s.          M. 

applied  on  cotton  to  carious  cavity.  Signa. — Introduce    on    a    pledget    of 

For  Neuralgia  and  Odontalgia. 

R  .    Menthol gr.v  For  Odontalgia. 

Olei  caryophylli  (or  oil  R  ,    Menthol 5  parts 

ofcajeput)  .    .    .    .  fgj.  M.  Chloroform     .    .    .    .  8  parts.    M. 

SiGNA. — To  be  painted  on  affected  part,  Signa. — Apply  on  cotton. 
or,  for  odontalgia,  applied  on  cotton.  ^       .     ,         ,     . 

LOCAL   AN.«STHETIC.  Dr.    A.    W.    HaRLAN. 

For  Abscesses,  Boils,  Felons,  etc.  g,  _    Menthol 2  parts 

R.    Chloroformi     .    .    .    .  gv  Ether 15  parts 

Ether  sulphurici     .    .   gj  Chloroform     .    .    .  100  parts.    M. 

Menthol ^ss.         M.  SiGNA. — For   injection,  or   applied   on 

SiGNA. — Use  with  spray  apparatus.  cotton  about  tooth. 

METHYLENE— BICHLORIDE   OF   METHYLENE. 

Formula. — CHg.Clg. 

Derivation. — Methylene  is  obtained  by  the  action  on  chloro- 
form of  nascent  hydrogen.  It  boils  at  104°  F.  and  40°  C.,and 
is  a  colorless,  volatile  liquid  with  the  odor  of  chloroform.     It 


426  DENTAL  MEDICINE. 


was  introduced  in  1840  by  Dr.  B.  W.  Richardson.  It  is 
pleasant  to  inhale  in  the  form  of  vapor.  Its  specific  gravity  is 
1.344,  and  evaporates  more  easily  than  chloroform,  and,  the 
vapor  being  denser,  it  requires  a  less  quantity  than  ether.  It 
is  soluble  in  alcohol  and  ether,  and  is  frequently  combined 
with  other  agents  to  lessen  its  cost. 

Medical  Properties  and  Therapeutic  Uses. — Methylene  pos- 
sesses many  of  the  dangerous  qualities  of  chloroform  when 
used  as  a  general  anaesthetic,  and  death  results  from  syncope 
with  dilated  pupils.  It  was  a  favorite  anaesthetic  with  Dr. 
Richardson,  and  Sir  Spencer  Wells  believes  that  it  has  all  the 
advantages  of  complete  anaesthesia  with  fewer  drawbacks  than 
any  other.  He  gives  it  diluted  with  air  by  Junker's  apparatus, 
and  it  is  supposed  that  he  employs  a  mixture  of  methylic 
alcohol  and  chloroform. 

Despite  the  fact  that  so  eminent  a  surgeon  as  Sir  T.  Spencer 
Wells  uses  methylene  as  an  anaesthetic,  and  has  continued  to 
advocate  its  use  for  twenty  years,  very  few  have  followed  his 
example.  This  is  because  the  statistics  of  mortality  "from  this 
anaesthetic  apparently  show  it  to  be  considerably  more  dan- 
gerous than  ether. 

A  recent  fatal  case  at  the  Plymouth  Hospital  has  called  out 
a  letter  from  Sir  Spencer,  in  which  he  states  that  this  and 
other  accidents  have  been  due  to  improper  administration. 
He  says  :  "  I  have  never,  either  in  hospital  or  private  practice, 
since  I  began  to  operate  in  1870  under  methylene,  seen  any- 
thing approaching  to  danger  under  its  influence,  nor  have  I 
had  a  moment's  uneasiness  or  apprehension  such  as  I  have 
repeatedly  suffered  during  the  administration  of  chloroform, 
ether,  the  A.  C.  E.  mixture,  laughing-gas  followed  by  ether, 
or  the  mixtures  of  chloroform  and  alcohol  which  some  have 
supposed  to  be  identical  with,  or  substitutes  for,  methylene. 
And  it  is  very  seldom  that-  in  most  prolonged  operations — 
say,  for  an  hour — more  than  from  six  to  eight  drachms  of  me- 
thylene are  used  ;  while  I  have  repeatedly  found  that  in  opera- 
tions of  fifteen  or  twenty  minutes,  not  more  than  from  two  to 
three  drachms  have  been  evaporated." 


MICROCIDINE.  427 


METHYLIC  ETHER— METHYL-ETHYLIC  ETHER. 

Formiila, — (C  1^3)20. 

Derivation. — Methylic  Ether  is  obtained  by  digesting  me- 
thylic  alcohol  with  strong  sulphuric  acid.  It  is  a  gaseous 
substance,  of  an  ethereal  odor,  and  under  the  nani'e  of  methyl- 
ethylic  ether,  it  has  been  used  as  a  general  anaesthetic.  The 
methylic  ether  is  prepared  for  use  as  methyl-ethylic  ether  by 
frequent  washings  in  a  strong  solution  of  potassa,  and  is  after- 
wards dissolved  in  absolute  ethylic  ether.  In  order  that  it 
may  be  fit  for  use,  it  is  necessary  to  keep  it  for  some  time 
securely  stopped. 

Dental  Uses. — According  to  Dr.  B.  W.  Richardson,  of  Eng- 
land, methylic  ether  is  a  superior  anaesthetic  for  dental  opera- 
tionsr — better,  he  says,  than  nitrous  oxide  gas,  because  it  allows 
air  to  be  given  with  it,  and  does  not  asphyxiate  nor  produce 
muscular  spasms  and  syncope.  Under  its  influence,  the  patient 
is  in  a  state  of  semi-consciousness,  but  is  not  conscious  of  pain 
from  an  operation, 

MICROCIDJN— MICROCIDINE. 

Derivation. — Microcidin  is  a  combination  of  naphthol  and 
soda.  Napthol  25  per  cent,  and  sodium  naphtholate  75  per 
cent.,  one  part  being  soluble  in  three  parts  of  water.  Micro- 
cidine  does  not  corrode  instruments  or  dressing  materials,  and 
is  without  odor  or  taste. 

Medical  Properties  and  Therapeutic  Uses. — Microcidin  has  a 
very  feeble  toxicity,  is  caustic  in  large  quantities,  but  in  me- 
dicinal doses,  even  the  largest  required,  is  not  irritating  when 
applied  to  wounds  as  an  antiseptic  and  disinfectant ;  it  may 
also  be  used  for  toilet  purposes.  It  reduces  fever  rapidly,  and 
is  excreted  by  the  urine,  which  is  rendered  aseptic.  It  has 
been  employed  successfully  in  a  large  number  of  cases  of  in- 
fected and  operative  wounds.  It  is  used  in  aqueous  solution 
in  the  strength  of  5  to  looo  (strong  solution)  and  3  to  lOOO. 

Dental  Uses. — As  an  antiseptic  and  disinfectant,  microcidin 
may  be  employed  in  dental  practice  on  gangrenous  pulps, 


428  DENTAL  MEDICINE. 


carious  cavities  in  pulp-canals,  and  wounds  and  ulcers  of  mu- 
cous membrane ;  and  as  a  disinfectant  and  antiseptic  generally. 

MORPHINA— MORPHINE. 

Formula. — C1YH19NO3+  HgO. 

Derivation. — Morphine  is  the  alkaloid  which. constitutes  the 
chief  na,rcotic  principle  of  opium,  the  proportion  varying  from 
10  to  15  per  cent.  It  is  present  in  opium  in  combination  with 
meconic  acid  and  the  meconate  of  morphia  is  separated  by 
repeated  macerations  with  water,  after  which  the  salt  is  decom- 
posed by  alcohol  and  water  of  ammonia,  the  latter  precipitating 
the  morphine  and  the  former  taking  up  the  coloring  matter  as 
soon  as  it  is  freed  from  the  alkali.  The  crystals  of  morphine 
are  then  boiled  in  alcohol  and  the  solution  filtered  through 
animal  charcoal.  Morphine  is  in  the  form  of  white,  or  color- 
less crystals,  which  are  inflammable  and  freely  soluble  in  boil- 
ing alcohol,  scarcely  soluble  in  cold  water,  and  somewhat  so 
in  boiling  water.  The  salts  of  morphine,  however,  are  freely 
soluble  in  water.  It  is  without  odor,  and  has  a  very  bitter 
taste.  Morphine  differs  somewhat  in  its  mode  of  action  from 
opium,  which  may  arise  from  the  peculiar  state  of  combination 
in  which  it  exists  in  opium.  Morphine  is  more  insoluble 
than  its  salts,  and  for  this  reason  the  latter  are  preferred  for 
administration. 

Medical  Properties  and  Action. — Morphine  is  more  powerful 
than  opium ;  but  it  causes  less  vascular  and  arterial  excite- 
ment, less  headache  and  vertigo,  less  subsequent  depression, 
less  constipation,  and  often  it  will  be  retained  on  an  irritable 
stomach,  when  opium  or  its  tincture  (laudanum)  would  be 
rejected. 

Morphine  is  indicated  when  the  object  is  to  relieve  nervous 
irritability  and  induce  tranquillity.  The  effects  of  morphine 
differ  according  to  the  peculiarities  of  nervous  constitution. 
The  hypnotic  effect  may  be  produced  and  the  stimulant  action 
be  confined  to  the  heart ;  in  some  cases  the  excitant  effect  pre- 
vails, or  the  two  effects  may  be  equal.  The  excitant  effect 
•  may  counteract  the  hypnotic  effect  to  a  greater  or  less  degree, 


MORPHINE.  429 


resulting  in  insomnia  with  restlessness,  or  even  delirium. 
Females  appear  to  be  more  liable  to  its  excitant  effects  than 
males ;  and  if  there  is  present  a  highly  emotional,  excitable 
and  energetic  temperament,  it  causes  great  distress  and  danger- 
ous effects  when  hypodermically  administered. 

Therapeutic  Uses. — Morphine,  in  the  form  of  salts,  is  em- 
ployed as  an  anodyne  and  hypnotic  in  neuralgic  affections, 
diseases  of  the  heart,  painful  uterine  affections,  and  in  all  cases 
of  painful  affections.     (See  Opium.) 

The  principal  salts  of  morphine  are  the  acetate,  the  hydro- 
chlorate  and  the  sulphate. 

MORPHINE  ACETAS— ACETATE  OF  MORPHINE. 

Formula. — CiyHjgNOg,  C2H4O2+3H2O. 

Derivation. — Acetate  of  Morphine  is  obtained  by  precipi- 
tating morphine  from  the  hydrochlorate  of  morphine,  by  the 
aid  of  ammonia,  the  precipitate  resulting  being  washed  in 
distilled  water  and  dissolved  and  neutralized  by  acetic  acid, 
after  which  it  is  evaporated  and  dried  by  heat.  It  is  in  the 
form  of  a  white  or  yellowish-white,  amorphous  or  crystalline 
powder,  altogether  soluble  in  water  and  alcohol,  and  of  a 
bitter  taste. 

MORPHIN.E  HYDROCHLORAS  OR  MURIAS— HYDROCHLORATE  OR  MURIATE 

OF  MORPHINE. 

Formula.— Qy;^^^'^0^,  HCI+3H2O. 

Derivation. — Hydrochlorate  or  Muriate  of  Morphine  is  ob- 
tained by  macerating  opium  in  distilled  water,  evaporating  to 
a  small  quantity,  and  adding  chloride  of  lime,  and  concen- 
trating the  solution  until  it  becomes  solid  when  cool,  after 
which  it  is  pressed,  washed  with  distilled  water,  again  evapor- 
ated, cooled  and  pressed,  and  again  dissolved  in  distilled  water, 
when  it  is  subjected  to  animal  charcoal,  to  remove  the  color- 
ing matter,  filtered  and  precipitated  by  ammonia,  the  codeia  of 
the  opium  remaining  in  solution.  The  crystals  resulting  are 
then  dissolved  in  muriatic  acid,  and  the  morphine  allowed  to 
crystallize  into  hydrochlorate  or  muriate  of  morphine.  It  is 
in  the  form    of   snow-white,   feathery,    flexible  and  acicular 


430  DENTAL  MEDICINE. 


crystals,  of  a  bitter  taste  and   silky  lustre,  and  altogether  sol- 
uble in  water  and  alcohol. 

MORPHINE  SULPHAS— SULPHATE  OF  MORPHINE. 

Derivation. — Sulphate  of  Morphine  is  obtained  by  dissolving 
morphine  in  boiling  alcohol,  and  saturating  it  while  hot  with 
sulphuric  acid,  the  coloring  matter  being  removed  by  animal 
charcoal ;  it  is  then  boiled  and  filtered  while  at  the  boiling 
temperature.  Upon  cooling  the  sulphate  is  deposited  in  the 
form  of  white,  feathery,  acicular  crystals,  of  a  silky  lustre, 
odorless,  with  a  bitter  taste  and  a  neutral  reaction.  It  is  solu- 
ble in  water  and  alcohol. 

Medical  Properties  and  Action  of  the  Salts  of  Morphine. — 
The  salts  of  morphine  possess  anodyne,  hypnotic  and  anti- 
spasmodic properties,  and  are  less  stimulating,  less  convul- 
sant,  and  more  hypnotic  and  anodyne  than  opium,  and  they 
also  produce  less  constipation,  and  less  diaphoretic  action  than 
opium.  After  the  administration  or  insertion  of  the  ordinary 
dose,  which  is  one-sixth  to  one-fourth  of  a  grain,  there  is 
experienced  a  sense  of  heat  and  flushing  of  the  face,  which 
may  be  preceded  by  some  pallor,  a  fullness  of  the  head,  giddi- 
ness, noise  in  the  ears,  and  frequently  nausea,  sometimes  epi- 
gastric pain.  ,  The  vertigo  may  cause  a  staggering  walk  and 
inability  to  maintain  an  upright  position.  Injection  of  the 
conjunctiva  and  contraction  of  the  pupils  occur  at  the  same 
time  that  the  cerebral  effects  are  felt.  The  lips  have  a  bluish 
appearance,  the  mouth  and  tongue  dry,  deglutition  is  painful 
and  the  voice  becomes  husky.  During  these  symptoms  the 
anodyne  effects  are  manifested  by  the  relief  of  pain  and  spasm, 
with  perfect  calmness  of  mind  and  tranquillity.  While  the 
effect  is  generally  hypnotic,  yet  in  some  cases  there  is  extreme 
wakefulness,  with  great  mental  activity,  and  when  sleep  occurs, 
instead  of  its  being  calm,  the  respirations  are  slow,  noisy  and 
labored,  the  patient  being  disturbed  by  dreams  and  visions. 
While  the  action  of  the  heart  is  diminished  in  frequency,  there 
is  a  considerable  rise  in  the   arterial  tension.     When  a  hypo- 


MORPHINE.  431 


dermic  injection  of  morphine  has  been  made,  there  is  experi- 
enced an  itching  of  the  nose,  which  may  extend  to  the  entire 
cutaneous  surface.  The  skin,  which  is  at  first  dry,  becomes 
moist,  from  diaphoresis,  which  is  sometimes  profuse.  The 
secretions  of  the  mucous  surface  are  also  arrested  as  a 
primary  effect. 

If  morphine  is  administered  after  a  full  meal,  its  effect  is  to 
suspend  digestion  for  some  time,  and  also  to  temporarily  arrest 
the  intestinal  movements  and  diminish  the  urinal  discharge, 
and  make  its  emission  difficult  on  account  of  the  temporary 
loss  of  contractile  power  of  the  bladder  and  of  the  ejaculatory 
muscles.  When  the  narcotic  effects  of  morphine  dechne, 
there  is  generally  experienced  headache,  confusion  of  mind, 
anorexia  and  nausea.  When  a  poisonous  dose  is  adminis- 
tered, a  profound  state  of  narcotism  quickly  ensues,  the  pulse 
becomes  slow  and  feeble,  the  respiration  slow  and  indistinct, 
the  skin  cold  and  covered  with  perspiration,  the  face  pale, 
blue  and  ghastly,  the  conjunctiva  deeply  injected,  the  pupils 
greatly  contracted,  the  reflex  movements  entirely  destroyed. 
Half  a  grain  of  morphia  is  the  smallest  dose  which  has 
proved  fatal  to  an  adult,  but  other  cases  are  recorded  where 
one  grain  destroyed  life.  It  chiefly  affects  the  cerebro-spinal 
functions,  and  causes  death  by  paralyzing  the  respiratory 
muscles. 

The  antidotes  in  cases  of  poisoning  are  the  stomach  pump, 
emetics,  cold  effusions,  counter-irritation,  strong  coffee,  active 
stimulants,  atropine  by  hypodermic  injection,  electro-mag- 
netism, and  artificial  respiration. 

Therapeutic  Uses. — The  salts  of  morphine  are  employed  in 
all  neuralgic  affections,  for  the  relief  of  pain  from  whatever 
cause,  and  to  induce  sleep  ;  also  in  diseases  of  the  heart, 
chronic  gastritis,  delirium  tremens,  tetanus,  colic,  spasms,  dys- 
entery, cholera,  cough  of  pulmonary  affections,  cerebro-spinal 
meningitis,  puerperal  fever,  convulsive  diseases,  vomiting, 
colica  pictonum,  diarrhoea,  diabetes,  gangrene,  etc.,  etc.  For 
hypodermic  injection,  the  acetate  of  morphine  is  supposed  to 
possess  some  advantages  over  the  other  salts,   such  as  the 


432  DENTAL   MEDICINE. 


sulphate  and  muriate,  one  of  which  is  its  greater  solubility. 
Morphine  is  contra-indicated  where  there  is  a  tendency  to 
apoplexy  and  coma. 

Dose. — Of  the  salts  of  morphine,  gr.  \  to  gr.  \.  One 
sixth  of  a  grain  of  either  of  the  salts  of  morphine  is  equiva- 
lent to  a  grain  of  opium,  or  twenty-five  drops  of  the  tincture 
of  opium  (laudanum). 

For  hypodermic  injections  the  dose  of  salts  of  morphine 
is  gr.  \  to  \.  The  use  of  morphine  hypodermically  frequently 
leads  to  the  morphine  habit,  which,  once  formed,  is  rarely 
abandoned;  and  which,  independent  of  its  fatal  systematic 
effects,  has  very  injurious  effects  upon  the  teeth — the  enamel 
and  dentine  becoming  thoroughly  disintegrated,  owing  to  the 
presence  of  erosive  acids. 

For  endermic  application,  gr.  ^  to  j  of  morphine  may  be 
sprinkled  on  a  surface  (which  has  been  blistered  to  remove 
the  cuticle),  over  the  seat  of  pain;  but  the  hypodermic  method 
is  the  most  effectual. 

Dental  Uses. — For  dental  use  the  acetate  of  morphine  and 
the  muriate  of  morphine  are  preferable  to  the  sulphate,  on 
account  of  their  greater  solubility  and  greater  chemical  affin- 
ity with  the  tissues  on  which  they  are  to  act.  The  acetate  of 
morphine  is  also  preferred  to  the  other  salts  as  an  ingredient 
of  nerve  paste  for  destroying  the  vitality  of  the  pulps  of  teeth, 
on  account  of  its  chemical  and  mechanical  compatibility  with 
the  pulp  tissue,  giving  relief  as  an  anodyne  when  the  sulphate 
would  irritate.  Concerning  the  action  of  morphine  when 
combined  with  arsenious  acid,  its  effect  is  anodyne,  modifying 
the  irritant  action  of  the  arsenic,  and  preventing  to  a  consid- 
erable degree  the  intense  pain  which  follows  its  application  to 
vitalized  structures.  Besides  its  use  in  devitalizing  mixtures 
and  as  an  obtunder  of  sensitive  dentine,  morphine  is  employed 
for  the  temporary  relief  of  odontalgia,  for  such  a  purpose 
being  combined  with  carbolic  acid,  sweet  spirits  of  nitre,  oil 
of  cloves  and  other  anodyne  agents. 

A  paste  made  of  acetate  of  morphine  and  creasote  (or  car- 
bolic acid)  is  much  used  for  obtunding  the  sensitiveness  of 


MYRRH. 


433 


dentine.  A  thin  paste,  made  of  acetate  of  morphine  rubbed 
up  with  oil  of  cloves,  is  an  excellent  application  for  exposed 
pulps;  also  a  mixture  of  acetate  of  morphine,  grs.  v;  oil  of 
cajeput,  foj  ;  applied  on  a  pledget  of  cotton.  The  latter  is 
also  effective  for  the  pain  following  tooth  extraction;  it  is  ap- 
plied on  cotton  in  the  alveolar  cavity. 

For  internal  administration  in  facial  and  other  neuralgias, 
morphine  is  combined  with  atropine  in  the  proportion  of 
atropine,  gr.  ^i^.  to  ^i^ ;  morphine,  gr.  i.  to  i ;  hypodermi- 
cally  injected.  Morphine  in  combination  with  carbolic  acid 
is  also  employed  to  relieve  the  pain  of  an  exposed  and  painful 
pulp. 

DENTAL    FORMULA. 

.     .    .     .  q.  S.  M. 


For  Odontalgia, 
White. 
R .    Morphinas  acetatis .    .    gr.xx 
Olei  caryophylli 
Spiritus     EEtheris    ni- 

trosi aa  ^ij.         M. 

SiGNA. — Apply  on  a  pellet  of  cotton. 

For  OdoTitalgia. 
R.    Morphine  acetatis  .    .  gr.xx 
Creasoti  (vel  acidi  car- 

bolici) ......  ^ij.         M. 

SiGNA. — Apply  to  carious  cavity  on  a 
pellet  of  cotton. 

For  Itchiftg  of  Inflamed  Surfaces, 
R .    Morphinre  sulph.    .    .  gr.yj 
Sodii  boratis    .    .    .    .  §  ss 

Aquae  rosse f^viij.    M. 

Sign  A. — To  be  used  as  a  lotion. 

For  Derdializin^ 
R .    Morphinte  acetatis  .    .  gr.j 


Ptilps  of  Teeth, 
Morphinte  acetatis . 
Acidi  arseniosi   .    . 


Creasoti q.  s 

Fiat  massa. 
SiGNA. — Apply  a  sufficient  quantity  to 
exposed  surface  of  pulp,  on  cotton. 

For  Abraded  Surfaces  of  Teeth, 
Dr.  a.  C.  Hugenschmidt. 
To  prevent  pain  of  friction. 
R.    Morphinse  murias  .    .    gr.ij 
Mur.  cocaini   ....   gr.ij 

Sodii  boras ^  j 

Mellis  .......  gj.  M. 

To  Relieve  the  Pain  following  Ex- 
traction of  Teeth,  and  a  Local  Attcss- 
thetic. 

R.    Morphinse gr.vj 

Tiucturse  aconiti, 
Chloroformi, 

Alcoholis    .    .    .    .  aa  f^^j.         M. 
SiGNA. — Apply  on   cotton,  or  with  an 
applicator,  as  a  local  anaesthetic. 
(See  Formulae  under  Arsenious  Acid.) 


MYRRHA— MYRRH. 


Source. — Myrrh  is  a  gum-resinous  exudation  from  a  small, 
shrubby  tree — Balsamodendron  Myrrha,  of  the  natural  order 
Aniyridacecs,  growing  in  Arabia  and  the  northeastern  coast  of 
28 


434  DENTAL   MEDICINE. 


Africa.  It  is  obtained  in  the  form  of  small,  irregular  frag- 
ments or  tears,  or  in  larger  masses,  composed  of  agglutinated 
portions.  The  juice  exudes  spontaneously  from  the  stem  of 
the  tree,  and  concretes  upon  the  bark.  When  pure,  myrrh  is 
of  a  reddish-yellow  or  reddish  brown  color,  translucent,  with 
a  strong,  peculiar  fragrant  odor  and  a  bitter  aromatic  taste, 
brittle  and  pulverizable.  Its  powder  is  of  a  light  yellow 
color  ;  when  of  a  dark  color  it  is  impure.  When  powdered 
myrrh  is  rubbed  up  for  fifteen  minutes  with  an  equal  weight 
of  muriate  of  ammonia  and  fifteen  times  its  weight  of  water 
gradually  added,  and  it  dissolves  quickly  and  entirely,  it  may 
be  considered  pure. 

Medical  Properties  and  Action. — Myrrh  is  stimulant,  astrin- 
gent, expectorant  and  emmenagogue.  It  stimulates  the  digest- 
ive organs  and  improves  the  appetite.  In  large  doses  of  a  half 
ounce,  it  causes  a  burning  sensation  in  the  stomach,  increased 
arterial  excitement,  and  profuse  diaphoresis,  with  a  great  influ- 
ence on  the  urinary  passages.  It  diminishes  discharges  from 
mucous  membrane  when  internally  administered,  and  is  a 
useful  external  application  for  relaxed  tissues. 

Therapeutic  Uses. — Myrrh  is  internally  administered  in 
chronic  catarrh,  humoral  asthma,  amenorrhoea,  chlorosis,  leu- 
corrhoea,  chronic  bronchitis,  etc.,  etc.;  and  in  combination  with 
chalybeates  and  aloes  in  uterine  affections. 

Locally,  myrrh  is  applied  to  inflamed,  ulcerated  and  aphthous 
surfaces. 

Dose. — Of  powdered  myrrh,  gr.  x  to  5ss,  in  pill  or  suspended 
in  water. 

Tincture  OF  Myrrh — Ti^ictiira  Myn^hce  {myrxh.,'^\\];  alco- 
hol, Oij).  Dose. — f5ss  to  f5j.  Is  used  internally  and  exter- 
nally. 

Dental  Uses. — Myrrh,  in  the  form  of  the  powder  and  tincture, 
is  employed  as  a  local  application  to  inflamed,  ulcerated  and 
spongy  gums,  ulcerations  of  mucous  membrane  of  the  mouth 
and  throat,  in  the  form  of  a  gargle;  also  in  alveolar  pyorrhoea, 
mercurial  stomatitis,  indolent  ulcers,  aphthous  sore  mouth  of 
children.     The  diluted  tincture  forms  a  stimulating  gargle  or 


Van    VahaKs   Obtunder  and  Local 
Anmsthetic. 


MYRTOL.  435 

mouth-wash,  and  the  powder  is  employed  as  an  ingredient  of 
dentifrices,  for  its  stimulating  and  astringent  properties. 

DENTAL  FORMULA. 

Astringent  Mouth    Wash.  Macerate   for  7  days  and   filter;    to 

R     Myrrhee  ftinct  )           .   5vi  filtrate  add  15  ounces  of  simple  syrup. 

Rad.  iridis ^vj 

Benzoini ^^  iij 

Cort.  cinchonje   .    .    .   §iv 

Ext.  kramerije    .    .    .  ^  ss  R .    Pip.  menthol  .    ,,   .    .  5  ij 

Capsici ^j  Tinct.  myrrh  .    .    v   •  ^vj 

Spt.  rectificat  ....    Cong.j.  M.  Alcohol gx.         M. 

MYRTOL.— RECTIFIED    MYRTLE   OIL. 

Derivation. — Myrtol  is  obtained  from  the  leaves  and  berries 
of  the  Myrtus  Communis  (Myrtaceae)  an  evergreen  shrub 
native  of  the  Mediterranean  countries.  It  is  a  volatile  oil  con- 
taining various  terpenes,  cineol,  and  a  camphor-like  substance. 

Medical  Properties  and  Therapeutic  Uses. — Myrtol  is  a  disin- 
fectant and  antiseptic,  and  causes  no  irritation  to  the  skin. 
Upon  a  denuded  or  abraded  surface  it  causes  a  slight  burning 
sensation,  which  soon  passes  off.  It  is  claimed  that  a  9  per 
cent,  solution  of  myrtol  will  completely  arrest  the  growth  of 
the  micro-organisms  of  pus;  and  myrtol  will  also  prevent  the 
decomposition  of  organic  matters.  Internally  myrtol  promotes 
digestion,  but  large  doses  cause  headache  and  nausea.  It 
communicates  a  violet  odor  to  the  breath  and  urine,  and  is 
eliminated  from  the  system  by  the  lungs  and  kidneys. 

Myrtol  has  been  employed  with  success  as  a  disinfectant  for 
wounds  and  ulcers;  also  in  cutaneous  diseases  of  a  vegetable 
parasitic  origin,  and  as  a  local  remedy  in  psoriasis.  Internally, 
myrtol  has  proved  useful  in  the  destruction  of  intestinal 
worms;  also  in  chronic  bronchitis,  gangrene  of  lungs,  pulmon- 
ary tuberculosis,  chronic  pyelitis  and  cystitis  ;  also  in  passive 
hemorrhage. 

Dose. — gr,  iv. 

De?ital  Uses. — Myrtol  is  employed  in  dental  practice  as  a 
disinfectant  of  pulp  canals  and  as  an  antiseptic  for  gangrenous 
pulps,  also  to  destroy  the  growth  of  micro-organisms  in  alveolar 


436  DENTAL  MEDICINE. 

abscesses,  and  to  disinfect  carious  cavities  in  teeth,  and  as  a 
mouth-v/ash  in  inflammation  of  the  mucous  membrane,  etc.,  etc. 

NAPHTHALENE— NAPHTHALIN. 

Fornmla — CioHg. 

Derivation. — Naphthalene  may  be  obtained  by  subjecting 
coal-tar  to  a  distillation,  when  it  passes  over  the  coal  naphtha. 
It  is  purified  by  subliming  it  with  charcoal,  and  is  then  in  the 
form  of  a  white,  crystalline  body.  It  has  a  slightly  aromatic 
taste  and  the  odor  of  coal-tar.  While  it  has  no  poisonous 
effect  on  man  and  the  higher  animals,  it  is  destructive  to  fungi 
spores,  small  insects,  etc.  It  is  soluble  in  alcohol,  ether, 
naphtha  and  the  oils,  but  insoluble  in  water.  As  an  expec- 
torant it  has  been  used  in  humoral  asthma  and  in  chronic 
pulmonary  catarrh,  in  doses  of  from  gr.  viii  to  xxx,  in  syrup 
or  emulsions,  and  as  an  ointment  in  skin  diseases  of  a  scaly 
nature;  also  as  a  vermifuge  in  doses  for  adults  of  gr.  xv, 
followed  immediately  by  2  ounces  of  castor  oil.  Naphthalin  is 
a  powerful  antiseptic,  and  can  be  used  as  a  substitute  for  iodo- 
form, with  the  advantage  of  not  producing  any  constitutional 
action.  Its  application  causes  a  slight  pain  of  short  duration. 
As  an  antiseptic  and  disinfectant  it  is  applied  to  indolent  ulcers, 
septic  and  unhealthy  wounds,  ulcerating  cancerous  growths, 
phagedenic  ulcers,  etc.  It  is  said  that  its  antiseptic  property 
is  superior  to  that  of  carbolic  acid,  and  as  an  odorless  prepara- 
tion, it  will  no  doubt  become  a  desirable  substitute,  as  it  has 
no  corrosive  action  and  will  not  injure  textile  fabrics.  To  deo- 
dorize naphthalin,  simple  mixture  with  benzoic  acid  or  tincture 
of  benzoin  does  not  suffice;  but  if  mixed  with  benzoin  and 
then  sublimed,  it  loses  its  tarry  odor  and  acquires  a  pleasant 
smell  which  it  retains. 

NAPHTHOL— NAPHTHOL. 

Forniida. — CioHgO^CioHgjOH. 

Derivation. — Naphthol  is  an  alcohol  derived  from  Naphtha- 
lene (CjoHg),  which  is  obtained  from  coal-tar  in  the  form  of 
white  shining  crystals  of  a  strong,  disagreeable  odor,  soluble 


NAPHTHOL.  437 


in  alcohol,  but  insoluble  in  water,  and  employed  locally  in 
indolent  ulcers  and  as  a  disinfectant  in  pus-pockets  and  wounds 
and  skin  diseases.     (See  Naphthalene.) 

Medical  Properties  and  Therapeutic  Uses. — There  are  two 
forms  of  Naphthol,  known  as  a  and  b  Naphthol,  the  latter 
being  employed  medicinally  on  account  of  its  less  irritating 
and  injurious  action.  It  is  in  the  form  of  light-brown  crystals, 
soluble  in  hot  water,  and  possessing  antiseptic  properties,  and 
employed  internally  and  locally  in  the  form  of  ointment  with 
vaselin  dissolved  in  alcohol,  ether  or  olive  oil,  in  the  proportion 
of  two  per  cent.  It  is  employed  in  parasitic  diseases  of  the 
skin,  and  as  a  general  antiseptic. 

HydronaphtJiol. — The  chemistry  of  this  agent,  which  is  sup- 
posed to  be  a  form  of  b  naphthol,  is  not  well  known.  It  is  in 
the  form  of  light  fawn-colored  crystalline  flakes,  having  a  feeble 
odor  and  taste.  As  a  germicide,  it  apparently  possesses  the 
power  of  preventing  the  development  of  germs  and  their  spores. 
It  resembles  capsicum  in  possessing  slight  stimulating  and 
counter-irritant  properties,  but  is  not  so  powerful. 

Dental  Uses. — Hydronaphthol  is  employed  for  treating  the 
canals  of  pulpless  teeth,  pericemental  inflammation  of  septic 
origin,  especially  in  the  early  stages  before  pus  has  formed. 
Dr.  Jas.  Truman  recommends  a  solution  of  i  :  looo  of  water 
for  injection  into  pulp-canals ;  and  Dr.  E.  C  Kirk  recom- 
mends a  paste  of  hydronaphthol  and  glycerine,  pumped  into 
a  thoroughly  cleansed  pulp-canal  in  pericemental  inflamma- 
tion from  septic  causes,  to  remove  the  soreness  and  inflam- 
mation in  a  few  hours :  it  should  be  retained  by  a  temporary 
filling  of  gutta  percha.  It  is  also  recommended  as  an 
ingredient  for  a  mouth-wash  for  diseased  gums  and  mucous 
membrane. 

AlpJia-oxynaphthoic  acid  (or  alpha-naphthol- carbonic  acid)  is 
prepared  in  a  similar  manner  to  salicylic  acid,  naphthol  being 
substituted  for  phenol.  Its  formula  is  CigHg.COOH.  It  is 
obtained  by  bringing  together,  under  strong  pressure,  and  at 
an  elevated  temperature,  alpha-naphthol,  sodium  and  carbonic 
acid  gas.     It  is  nearly  insoluble  in  water,  but  soluble  in  the 


438  DENTAL   MEDICINE. 


alkalies  and  alkaline  carbonates,  forming  salts,  which  are  color- 
less and  of  neutral  reaction,  and  more  soluble  in  hot  and  cold 
water  than  the  acid  itself.  It  is  antiseptic  and  germicide, 
experiments  upon  bacteria  giving  favorable  results. 

BENTAL   FORMULA. 

Antiseptic  and  Stimulant  Mouth- Wash. 

For  use  especially  in  Alveolar  Pyorrhoea. 

Dr.  Chas.  B.  Atkinson. 

R  .        Hydronaphthol s;  ij 

Tinct.  calendulse giv 

Aquae  dest.  q.  s.  ad ^^"j-  ^^• 

SiGNA. — Use  daily. 

Fragrant  and  Antiseptic  Mouth    Wash. 
Dr.  a.  W.  Harlan. 

R  .         Safrol 360  min 

Oil  of  pinus  pomilia 120  min 

Oil  of  curacoa 120  min 

Oil  of  vetivert 6  drops 

Oil  of  wintergreen 24  drops 

Oil  of  anise,  Saxony 6  drops 

Oil  of  rose  geranium,  Af. 6  drops 

Naphthol    .    .     • 60  grs 

Deodorized  alcohol 24  f.  oz 

Solution  of  saccharine  ............     J!^  f .  oz 

Glycerine 8  f.  oz 

Purified  talcum 2  troy  oz.     M. 

NITROUS   OXIDE— PROTOXIDE   OF   NITROGEN. 
LAUGHING  GAS. 

Formula. — NgO.     Sp.  gr.  compared  with  air  is  about  1.6. 

Derivation. — The  discovery  of  Nitrous  Oxide  Gas  was  made 
by  Dr.  Priestly  in  1776,  and  scientific  investigation  demon- 
strating its  respirability,  by  Sir  Humphrey  Davy,  the  results 
of  which  were  published  some  twenty  years  afterwards.  To 
Dr.  Horace  Wells,  a  dentist  of  Hartford,  Connecticut,  is  due 
the  credit  of  having  demonstrated  its  property  as  an  anaes- 
thetic agent  for  the  relief  of  pain  during  surgical  operations, 
in  the  year  1844.  Nitrous  oxide  is  obtained  by  heating  the 
salt  nitrate  of  ammonia  in  a  glass  retort  until  it  melts,  and 


NITROUS   OXIDE.  439 


then  boils,  dissolving  into  a  vapor  of  water  and  into  a  perma- 
nent gas. 

The  salt  nitrate  of  ammonia  is  obtained  in  three  forms — the 
crystallized,  the  granulated  and  the  fused.  The  fused  form  is 
prepared  by  melting  the  crystallized  nitrate  of  ammonia,  and 
allowing  it  to  solidify  on  cooling ;  the  granulated  is  prepared 
by  evaporating  the  solution  to  a  density  sufficient  to  solidify 
on  cooling,  and  agitating  the  mass  until  it  becomes  cool. 

As  it  is  very  important  to  use  a  pure  form  of  the  nitrate  of 
ammonia  in  the  generation  of  nitrous  oxide  gas,  the  salt 
either  in  the  fused  or  granulated  state,  may  be  tested  by  heat- 
ing it  on  platinum,  when  the  nitrate,  if  pure,  should  volatilize 
perfectly.  It  may  also  be  tested  by  a  few  drops  of  chloride 
of  barium,  which  should  not  give  a  precipitate  when  added  to 
the  nitrate  of  ammonia ;  should  it  do  so,  then  sulphuric  acid 
is  present ;  or,  the  nitrate  of  ammonia  may  be  tested  by  a 
solution  of  nitrate  of  silver,  which  will  also  give  a  precipitate, 
if  chlorine  is  present.  The  test  with  nitrate  of  silver  may  be 
made  by  dissolving  a  drachm  of  the  nitrate  of  ammonia  in 
half  a  glass  of  distilled  water  and  adding  a  few  crystals  of  the 
nitrate  of  silver.  If  the  nitrate  of  ammonia  is  pure,  the  solu- 
tion will  remain  perfectly  clear  ;  but  should  chlorine  be  pres- 
ent, it  will  show  a  clouded  appearance,  and  should  be  dis- 
carded, as  it  is  not  fit  to  generate  the  gas  from. 

The  salt  nitrate  of  ammonia  is  a  white,  crystalline  sub- 
stance, formed  by  neutralizing  dilute  nitric  acid  by  means  of 
carbonate  of  ammonia,  and  is  so  constituted  as  to  be  resolved 
into  nitrous  oxide  and  water.  A  pound  of  the  salt  will  gen- 
erate about  thirty  gallons  of  the  gas.  In  generating  nitrous 
oxide  gas,  care  must  be  taken  to  preserve  its  purity ;  conse- 
quently it  becomes  important  to  maintain,  as  nearly  as  possi- 
ble, an  equal  temperature  during  its  manufacture;  and  should 
any  nitric  oxide — binoxide  of  nitrogen — be  formed,  which 
may  be  done  by  too  high  a  heat  under  the  retort,  it  is  neces- 
sary to  remove  it  and  other  impurities,  by  the  aid  of  solu- 
tions of  caustic  potash  and  copperas ;  the  caustic  potash 
neutralizing  any    free  nitric  acid  present,    and  the  copperas 


440  DENTAL  MEDICINE. 


removing  either  chlorine  or  nitric  oxide.  The  salt  nitrate  of 
ammonia  is  perfectly  fused  at  226°  F.,  emits  white  fumes  at 
302°  F.,  and  begins  to  evolve  gas  at  460°  F.  At  500°  F. 
the  impurity,  nitric  oxide,  is  given  off;  hence  the  temperature 
during  the  process  should  not  be  permitted  to  rise  above 
482°  F.,  which  can  be  determined  by  thermometers  prepared 
for  the  purpose.     No  red  fumes  should  pass  from  the  retort. 

Liquefied  Nitrous  Oxide. — Nitrous  oxide  gas,  as  principally 
used  at  the  present  time,  is  in  the  form  of  condensed  gas, 
being  liquefied  and  solidified  under  great  pressure,  and  secured 
in  iron  cylinders,  from  which  it  escapes  into  an  inhaling  bag 
when  needed  for  use  by  turning  a  stop-cock.  Liquefied  nitrous 
oxide  is  a  colorless  fluid,  having  a  specific  gravity  of  0.908, 
and  at  a  very  low  temperature  (148°  F.)  it  congeals  into  a 
transparent  crystalline  solid.  It  is  prepared  by  condensing 
the  gas  by  a  pressure  of  fifty  atmospheres  at  a  temperature  of 
40°  F.,  and  may  be  kept  in  the  iron  cylinders  for  an  indefinite 
period.  The  advantages  of  the  condensed  form  of  the  gas  are 
its  purity,  convenience  for  use  whenever  needed,  the  large 
supply  which  can  be  kept  for  use,  and  the  freedom  from 
deterioration,  notwithstanding  its  age. 

Nitrous  oxide  is  an  elastic,  colorless  gas,  with  a  faint,  but 
agreeable  odor  and  a  sweetish  taste,  which  it  imparts  to  water. 
Under  a  pressure  of  fifty  atmospheres  at  about  40°  F.,  it 
becomes  a  clear  colorless  liquid,  and  at  about  148°  F.  below 
zero,  it  freezes  into  a  beautiful,  clear  crystalline  solid.  By 
the  evaporation  of  this  solid,  a  degree  of  cold  may  be  pro- 
duced far  below  that  of  carbonic  acid  bath  in  vacuo,  or  lower 
than  170°  F.  The  washing  of  nitrous  oxide  gas,  and  the 
retention  of  it  over  water  for  any  length  of  time,  is  attended 
with  considerable  loss,  as  much  of  it  is  absorbed,  especially 
if  the  water  is  cold ;  such  loss  may  be  avoided  to  a  great 
extent  by  using  water  of  an  elevated  temperature  or  a  strong 
solution  of  common  salt.  The  impurities  of  nitrous  oxide 
gas  are  air,  water,  nitric  oxide  or  binoxide  of  nitrogen,  chlorine 
and  hyponitric  acid.  The  mixture  with  air,  which  may  occur 
in  the  receiver,  or  when  the  patient  is  inhaling  the  gas,  merely 


NITROUS   OXIDE.  441 


dilutes  it,  as  does  also  the  vapor  of  water.  Nitric  oxide, 
however,  is  a  dangerous  impurity,  and  with  others  may  be 
generated  even  when  pure  nitrate  of  ammonia  is  used  in  pre- 
paring the  gas ;  this  impurity  is  also  one  of  the  most  difficult 
to  separate  from  the  gas.  Like  nitrous  oxide,  nitric  oxide  is  a 
colorless  gas,  lighter  and  less  soluble  in  water,  and  if  it  is 
generated,  is  liable  to  pass  through  the  washing  solutions  into 
the  gasometer  or  receiver ;  nitric  oxide,  however,  need  not  be 
generated  if  the  proper  care  is  observed  with  regard  to  the 
degree  of  heat  under  the  retort  which  contains  the  nitrate  of 
ammonia. 

Chlorine  is  also  a  dangerous  impurity,  and  may  be  set  free 
if  the  salt  nitrate  of  ammonia  contains  muriate  of  ammonia 
(sal-ammoniac)  and  chloride  of  ammonium.  To  prevent  such 
contamination,  the  tests  of  the  salt  before  referred  to  may  be 
made.  Nitrous  oxide  gas  supports  combustion  with  almost 
the  same  promptness  as  pure  oxygen  ;  and  although  nearly 
identical  in  constitution  with  atmospheric  air,  it  differs  from 
it  both  in  the  proportion  of  its  constitutional  elements  and  in 
the  manner  of  their  association.  Nitrous  oxide  contains 
about  one-third  of  oxygen  to  two-thirds  of  nitrogen,  while 
atmospheric  air  has  only  about  one-fifth  of  oxygen  to  four- 
fifths  of  nitrogen. 

Again,  in  nitrous  oxide  the  elements  nitrogen  and  oxygen 
are  in  chemical  combination  with  each  other,  while  in  atmos- 
pheric air  there  is  no  apparent  chemical  union  whatever. 

Medical  Properties  and  Action. — Concerning  the  therapeutic 
application  of  nitrous  oxide.  Dr.  L.  Turnbull  says:  "Neuralgia, 
uncomplicated,  will  sometimes  be  relieved  by  a  few  inhala- 
tions of  nitrous  oxide  gas.  Nervous  aphonia,  this  peculiar 
form  of  loss  of  power  over  the  voice,  usually  the  result  of 
hysteria,  will  be  much  improved  by  the  patient  inhaling  suffi- 
cient nitrous  oxide  gas  to  produce  a  partial  loss  of  sensation 
and  muscular  relaxation.  Local  paralysis  has  been  benefited, 
where  there  was  no  brain  lesion,  by  the  gentle  stimulation  by 
the  first  stages  of  the  gas,  or  the  tingling  and  stimulating 
effect  on  the  muscles.     Asthma,  when  of  a  spasmodic  charac- 


442  DENTAL   MEDICINE. 


ter,  is  often  much  improved  by  causing  the  patient  to  pass 
into  the  stage  of  relaxation,  employing  it  every  other  day  for 
a  week  or  two.  It  also  tends  to  expand  the  lungs."  Dr. 
George  J.  Ziegler  found  the  solution  of  the  gas,  in  water,  of 
much  utility  in  diseases  of  the  lungs,  kidneys,  and  other 
diseases  of  this  class.  Dr.  M.  Price  claims  to  have  employed 
nitrous  oxide  gas  in  many  cases  of  phthisis  with  advantage, 
and  a  number  of  dentists  have  been  told  by  consumptive 
patients  that  they  have  been  benefited  by  the  inhalation  of 
nitrous  oxide  gas. 

Nitrous  oxide  gas  is  not  only  the  most  pleasant,  but  is 
the  safest  general  anaesthetic  in  use,  and  the  greatest  objec- 
tion to  its  administration  is  the  very  short  anaesthetic  stage 
which  it  induces,  unless  the  inhalation  of  the  gas  be  continued, 
which  is  impossible  in  operations  upon  the  inouth.  When 
inhaled,  the  first  effect  is  dizziness,  with  ringing  noises  in  the 
ears,  a  tingling  sensation,  extending  to  the  extremities,  an 
uplifting  of  the  whole  system,  followed  by  fullness  or  expan- 
sion of  the  chest,  and  a  loss  of  sensation  throughout  the  entire 
body.  According  to  the  temperament,  the  stage  of  excite- 
ment is  transient  or  prolonged ;  in  some  cases  there  are 
strange  illusions,  with  a  form  of  intoxication,  which  may  be 
manifested  by  declamation,  singing,  laughing  or  crying,  or 
melancholy,  with  a  disposition  at  times  to  assault  all  near. 
Such  effects,  if  the  administration  is  interrupted,  soon  pass  off. 
For  surgical  operations,  the  gas  is  given  with  less  admixture 
of  air,  and  the  inhalation  persisted  in  until  the  stage  of  excite- 
ment is  overcome  and  insensibility  produced,  when  the  face 
becomes  extremely  pale,  the  respirations,  at  first  shallow,  be- 
come deep  and  stertorous,  the  jaw  fixed,  the  eyes  protruding, 
and  a  bluish  and  purplish  color  about  the  lips  and  face,  the 
patient  presenting  a  very  alarming  and  death-like  appearance, 
a  condition  of  which  Bartholow  says :  "  So  far  as  the  exterior 
phenomena  can  afford  any  indication  of  the  nature  of  the 
action,  is  a/i  asphyxiated  state.  The  blood  ceases  to  be  oxy- 
genated, carbonic  acid  accumulates,  and  the  centres  of  con- 
scious impressions  are  rendered  inactive  in  consequence  of  the 


NITROUS  OXIDE.  443 


deficient  supply  of  oxygen  and  the  excess  of  carbonic  acid. 
The  rational  indications  of  the  nature  of  the  narcosis  produced 
by  nitrous  oxide  are  confirmed  by  physiological  experiment. 
It  has  been  found  that  the  exhalation  of  carbonic  acid  is  de- 
cidedly diminished  by  the  inhalation  of  nitrous  oxide,  and  that 
animals  live  no  longer  in  an  atmosphere  of  this  gas  than  in  an 
atmosphere  of  hydrogen."  The  same  author  speaks  of  the 
fatal  cases  that  have  occurred,  as  being  with  propriety  attribu- 
table to  the  lethal  action  of  this  gas,  and  refers  to  various 
cases  under  his  own  observation  in  which  nervousness,  vague 
mental  symptoms  and  headache  have  been  experienced  after 
the  inhalations ;  at  the  same  time  he  pronounces  nitrous  oxide 
to  be  almost  free  from  danger.  Prof  H.  C.  Wood  believes 
that  nitrous  oxide  acts  as  an  ansesthetic  by  shutting  off  oxy- 
gen. There  is  no  doubt  but  that  the  prompt  action  of  nitrous 
oxide  gas,  and  the  rapid  subsidence  of  the  narcosis,  have  much 
to  do  with  its  safety,  and  account  for  the  impunity  with  which 
it  is  used.  Nitrous  oxide  gas  has  the  advantages  of  safety ; 
also  rapid  ansesthesia,  which  is  generally  induced  in  from  thirty 
seconds  to  a  minute  and  a  half,  insensibility  often  occurring 
before  complete  unconsciousness  ;  also  the  pleasant  odor  and 
taste,  thereby  preventing  repugnance  and  nausea;  and  the 
complete  recovery  from  its  influence  without  unpleasant  after- 
effects. It  generally  requires  six  gallons  or  less  to  produce 
anaesthesia  with  nitrous  oxide  gas;  hence  the  rubber  bag  from 
which  it  is  inhaled  should  have  a  capacity  of  about  eight 
gallons. 

Mode  of  Administration. — The  most  improved  apparatus 
consists  of  an  iron  cylinder  containing  lOO  gallons  or  more 
of  the  condensed  or  liquefied  nitrous  oxide,  to  which  is  at- 
tached a  rubber  gas  bag  and  inhaling  tube  with  a  double  valve 
and  mouth-piece.  The  patient,  for  dental  operations,  is  seated 
in  a  suitable  chair  which  will  admit  of  the  back  being  lowered 
to  such  a  degree  as  will  bring  the  patient  to  an  almost  hori- 
zontal posture,  and  the  head  well  supported.  A  piece  of  India 
rubber  or  a  firm  cork  to  which  a  thin,  strong  cord  is  attached, 
to  prevent  its  slipping  down  the  throat,  is  placed  between  the 


444  DENTAL   MEDICrNE. 


teeth,  so  as  to  prevent  the  closure  of  the  jaws,  for,  unlike  chlor- 
oform and  ether,  the  muscles  become  rigidly  contracted  under 
the  influence  of  this  gas;  such  a  prop  also  prevents  injury  to 
the  front  teeth  by  the  patient  biting  too  hard  on  the  mouth- 
piece of  the  inhaling  tube.  The  patient  is  then  directed  to 
breathe  deeply  and  regularly,  the  nose  being  held,  to  prevent 
the  admixture  of  atmospheric  air,  and  the  same  precautions 
observed  as  are  necessary  when  administering  ether  or  chloro- 
form. (See  Ether.)  The  anaesthetic  state,  or  "  surgical  period," 
as  it  is  termed,  is  generally  manifested  by  snoring,  although 
this  symptom  does  not  invariably  occur ;  when  it  does,  how- 
ever, it  indicates  a  state  of  profound  anaesthesia,  to  which  it  is 
unnecessary  to  carry  the  patient  when  performing  many  minor 
surgical  operations. 

As  more  or  less  excitement  follows  the  inhalation  of  this 
gas,  when  it  is  largely  mixed  with  atmospheric  air,  such  a 
condition  is  either  prevented  or  abbreviated  by  holding  the 
nose  of  the  patient  during  the  inhalation.  The  patient  should 
not  partake  of  food  for  at  least  two  hours  before  the  adminis- 
tration of  the  gas,  but  at  the  same  time  should  not  be  in  a 
weakened  condition  for  want  of  it ;  and  the  dress,  if  tight, 
should  be  previously  loosened,  and  as  soon  as  the  operation 
is  completed  the  head  should  be  gently  moved  to  one  side, 
to  allow  the  blood  to  escape  from  the  mouth.  Fresh  air  should 
then  be  admitted  into  the  room,  and  the  patient  supplied  with 
it  by  means  of  a  fan.     (See  Administration  of  Anaesthetics.) 

Therapeutic  and  Dental  Uses. — According  to  the  investiga- 
tions of  Dr.  Ziegler,  nitrous  oxide  is  an  efficient  restorative 
when  administered  either  in  its  gaseous  state  by  the  lungs,  or 
in  conjunction  with  liquids  by  the  alimentary  canal.  He 
recommends  the  use  of  this  gas  in  moderate  quantities,  so  as 
not  to  generate  too  much  carbonic  acid.  Regarding  nitrous 
oxide  and  oxygen  as  of  primary  importance  in  asphyxia,  and 
the  natural  antidotes  to  narcotizing  agents  and  asphyxiated 
conditions,  he  advocates  their  use  whenever  practicable,  either 
alone  or  in  combination  with  heat,  and  claims  that  they  will 
often  save  life  in  apparently  hopeless  cases. 


NUX   VOMICA.  445 


The  rapid  action  of  nitrous  oxide  and  the  transient  nature 
of  its  effects  on  the  system,  render  it  a  very  useful  anaesthetic 
agent  for  all  minor  surgical  operations — such  as  extracting 
teeth,  lancing  abscesses,  devitalizing  nerves  of  teeth,  etc.,  etc. 
It  has  also  been  successfully  employed  in  the  performance  of 
some  capital  surgical  operations,  where  the  anaesthesia  has 
been  kept  up  from  fifteen  minutes  to  half  an  hour.  It  has 
recently  been  recommended  to  use,  during  the  first  part  of  an 
inhalation,  the  pure  nitrous  oxide  gas,  and  for  the  purpose  of 
prolonging  the  anaesthesia  with  less  danger,  to  dispense  with 
the  pure  gas  and  administer  a  mixture  of  oxygen  and  nitrous 
oxide  in  proportions  very  similar  to  the  air  we  breathe.  It  is 
claimed  for  the  mixture  of  nitrous  oxide  and  oxygen,  absence 
from  all  blueness  of  the  features,  regular,  softly-snoring  breath- 
ing, muscular  relaxation,  and  absence  of  conjunctival  reflex  ; 
also  that  the  jerky  muscular  movements,  especially  common 
to  children  under  nitrous  oxide,  are  completely  abrogated,  and 
that  the  presence  of  oxygen  with  nitrous  oxide  renders  the 
anaesthesia  much  safer. 

NUX   VOMICA. 

Source. — The  seed  of  the  Stiychnos  mix  vomica,  \vhich  con- 
tains two  alkaloids,  stryclinine  and  bnicine,  the  amount  of 
strychnine  being  one-fourth  to  one-half  per  cent.,  and  of  bru- 
cine  from  one-eighth  to  one  per  cent. 

Strychnine. — Stryclinina  (C21H22N2O2) — is  a  white  or  gray- 
ish white  powder  of  a  very  bitter  taste,  almost  insoluble  in 
water,  and  very  soluble  in  boiling  alcohol. 

Sulphate  of  Strychnine. — Strychnines  Sulphas — is  a  white 
salt  in  the  form  of  colorless  prismatic  crystals,  which  are  very 
bitter  and  odorless,  soluble  in  ten  parts  of  water,  somewhat  so 
in  alcohol,  but  insoluble  in  ether. 

Medical  Properties  and  Tlicrapentic  Uses. — Nux  vomica 
and  strychnine  are  bitter  stomachic  and  muscular  tonics.  In 
small  doses  strychnine  increases  the  gastro-intestinal  secre- 
tions, hastens  intestinal  movements,  and  elevates  arterial  ten- 
sion.    In  larger  doses  the  pupils  are  dilated  and  the  muscles 


446  DENTAL  MEDICINE. 


spasmodically  contracted.  Poisonous  doses  cause  muscular 
tremors,  intermittent  tetanic  spasms,  and  death  from  rigidity  of 
the  respiratory  muscles,  without  any  impairment  of  the  mind. 

Poisonous  quantities  of  strychnine  accumulate  in  the  sys- 
tem, on  account  of  the  agent  being  slowly  excreted,  from  very 
small  doses  frequently  administered.  The  antidotes  are  free 
evacuation  of  the  stomach,  vegetable  astringents  to  precipi- 
tate the  strychnine,  and  the  inhalation  of  ether  or  chloroform, 
and  the  hypodermic  injection  of  chloral.  Strychnine  is  em- 
ployed in  anaemia,  atonic  dyspepsia,  constipation,  vomiting  of 
pregnancy,  gastralgia,  gastric  catarrh,  etc.,  of  drunkards, 
chlorosis,  purpura,  hemorrhagic  diathesis,  local  paralysis,  poi- 
soning by  lead,  spasmodic  asthma,  etc.,  etc.  It  is  an  antidote 
to  chloral,  and  nux  vomica  is  used  in  intermittent  fever  as  an 
adjunct  to  quinine.  Brucine  is  much  weaker  than  strychnine 
but  similar  in  its  action,  and  the  pure  agent  is  analogous  to 
cocaine,  possessing  local  anaesthetic  properties.  For  hypo- 
dermic injection  it  is  resorted  to  in  paraplegia,  infantile  paraly- 
sis, facial  paralysis,  etc.,  and  also  in  diseases  of  the  eye,  and 
infraorbital  paralysis.  A  half  grain  of  strychnine  has  pro- 
duced a  fatal  result,  and  one-twelfth  of  a  grain  will  produce 
muscular  twitchings,  and  one-sixteenth  of  a  grain  has  proved 
fatal  in  the  case  of  a  child. 

Dose. — Of  Abstractuni  nucis  vomiccE,  gr.  \\  of  Extractum 
micis  vo  J  niece,  gr.  ^  to  gr.  |-;  of  Extractum  nucis  vomiccB  flui- 
dum,  lUj  to  v;  of  Ti7ictura  nucis  vomiccE,  TTLv  to  x;  oi  Strychnina, 
gr.  eV  to  2V;  of  StrycJinincB  SulpJias,  gr.  -gV  to  -3V;  of  Brucine, 
gr.  tV  to  \. 

DENTAL    FORMULA. 

For  N'euralgia. 

R.       Ext.  nucis  vom gr.v 

Zinci  valerian 3*j 

Ext.  gentianas ^j. 

Fiat  pill  No.  XX. 
SiGNA.—  One  pill  3  or  4  times  a  day. 

OLEATES. 

Medicinal  oleates   are,  according  to   Dr.  J.  D.  Shoemaker, 

definite  chemical  compounds   or  salts,  having  no   excess  of 


OLEATES.  447 

either  their  acid  or  basic  radicals,  and"  Dr.  Lawrence  Wolff 
finds  that  the  best  and  readiest  method  of  preparing  oleates  is 
by  the  double  decomposition  of  sodium  oleates  with  solutions 
of  neutral  salts.  The  sodium  oleate  is  made  by  the  saponifi- 
cation of  oleic  acid  with  sodium  hydrate.  Dr.  Squibb,  how- 
ever, is  of  the  opinion  that  in  the  preparation  of  oleates,  none 
are  so  good  as  those  made  by  the  direct  union  of  the  acid  with 
the  dry  base,  without  heating,  and  that  the  preparation  should 
always  be  either  a  liquid  or  semi-solid  which  is  easily  and 
completely  liquefied  by  the  natural  temperature  of  the  surface 
to  which  it  is  applied;  and  he  further  says  that  in  the  rare 
cases  where  the  excess  of  acid  as  a  solvent  of  the  oleates 
proves  an  irritant  to  the  skin,  dilution  with  a  bland  oil  becomes 
admissible.  The  most  common  oleates  in  use  are  those  of 
mercury,  zinc,  lead,  copper,  aluminium,  bismuth,  iron,  arsenic, 
silver,  aconite,  atropine,  morphine,  veratria  and  strychnine. 
Oleates  of  the  more  active  alkaloids,  namely,  aconitia,  atropia, 
strychnia  and  veratria,  are  usually  made  of  the  strength  of  two 
per  cent,  of  the  alkaloid;  the  oleate  of  morphia  usually  con- 
tains five  per  cent,  of  the  alkaloid;  the  oleate  of  quinine 
usually  contains  twenty  per  cent,  of  the  alkaloid.  Dr.  Squibb 
says  that  all  of  these  are  very  simply  and  easily  made  by  put- 
ting the  weighed  quantity  of  the  alkaloid  into  a  mortar,  adding 
a  small  quantity  of  the  oleic  acid,  little  by  little,  and  triturating 
until  the  alkaloid  is  completely  dissolved.  The  strong  solu- 
tion thus  made  is  then  poured  into  a  tarred  bottle,  and  the 
mortar  and  pestle  rinsed  twice  into  the  bottle  with  small  quan- 
tities of  oleic  acid.  The  proper  weight  is  then  made  up  by 
the  addition  of  oleic  acid. 

According  to  the  preparation  of  oleates  as  recommended  by 
Dr.  Shoemaker — 

Oleate  of  Merciuy  is  prepared  by  precipitating  a  solution  of 
sodium  oleate  with  mercuric  chloride,  and  is  the  best  local 
stimulant  and  alterative  application  of  all  the  mercurials.  It 
may  be  diluted  with  either  the  paraffinates,  or,  better  still,  with 
lard  or  lard  oils.  When  applied  to  the  unbroken  skin  it  causes 
marked  stimulation,  bordering  on  congestion.     It  has   great 


448  DENTAL   MEDICINE. 


penetrating  power,  is  readily  absorbed  by  the  skin,  and  does 
not  become  rancid  nor  stain  the  linen.  It  is  a  valuable  remedy 
in  syphilis,  the  treatment  of  indurations  after  abscesses,  skin 
diseases  of  a  scaly  nature,  obstinate  ulcers,  parasitic  affections, 
etc.,  and  may  be  employed  advantageously  with  other  oleates. 
As  it  is  capable  of  producing  the  constitutional  effects,  it  must 
be  employed  carefully. 

A  mixture  of  oleate  of  mercury  gr.  x  to  xx,  with  the  oint- 
ment of  oleate  of  zinc  5j,  is  very  effective  in  chronic  acne  and 
eczema,  especially  in  the  fissured  variety  of  the  latter  common 
to  the  palmar  and  plantar  surfaces.  For  syphilitic  skin  erup- 
tions and  in  superficial  ulcers,  oleate  of  mercury  5j,  with 
oleate  of  bismuth  5iij,  or  the  same  quantity  of  the  ointment 
of  the  oleate  of  lead,  acts  promptly  and  efficiently.  For  one 
of  the  best  and  most  efficacious  oily  applications  for  loss  of 
hair,  especially  when  the  scalp  is  harsh  and  dry,  and  the 
hairs  dull  and  without  lustre,  a  preparation  composed  of 
oleate  of  mercury  5j  to  ij,  with  oil  of  ergot  Sj,  is  highly 
recommended. 

Oleate  of  Zinc  is  prepared  by  decomposing  a  sodium  oleate 
with  a  saturated  solution  of  zinc  sulphate,  boiling  out  and 
drying  the  precipitate  and  then  reducing  it  to  an  impalpable 
powder.  One  part  of  oleate  of  zinc  melted  with  three  parts 
of  lard  or  oil  gives  a  most  useful  ointment,  but  the  best  results 
are  obtained  from  the  oleate  of  zinc  alone.  It  is  in  the  form 
of  a  fine,  pearl-colored  powder,  having  a  soft,  soapy  feel,  much 
like  powdered  French  chalk.  It  is  valuable  in  all  forms  of 
sweating. 

Oleate  of  Lead  is  prepared  by  precipitating  a  sodium  oleate 
with  a  solution  of  lead  subacetate.  To  form  the  ointment  of 
lead  oleate,  the  washed  and  dried  precipitate  is  melted  with 
equal  parts  of  lard.  Oleate  of  lead  exerts  a  combined  seda- 
tive and  astringent  action  when  applied  to  denuded  skin,  and 
also  arrests  morbid  discharges,  protects  the  surface,  and  allays 
irritation.  It  is  useful  in  eczema,  acne  and  other  skin  diseases. 
For  skin  diseases,  oleate  of  lead  5ij,  with  oleate  of  bismuth 
5j,  is  very  effectual,  especially  in  the  fissured  form  of  palmar 


OLEATES.  449 

and  plantar  eczema  ;  and  when  the  cracking  is  very  deep,  to 
cause  stimulation,  oil  of  cade  gtt.  xx  to  xxx  may  be  added. 
In  scabies,  oleate  of  lead  5iv  with  sulphur  5ss  is  an  excellent 
application. 

Oleate  of  Abnninum  is  prepared  by  decomposing  sodium 
oleate  with  aluminum  sulphate.  The  washed  precipitate, 
mixed  with  equal  parts  of  lard,  forms  an  ointment  of  a  semi- 
solid, dark-brown  color,  which  is  very  astringent  in  its  action. 
It  rapidly  arrests  all  muco-purulent  discharges,  and  is  an  effi- 
cient dressing  for  foul  ulcers,  sinuses,  burns  and  scabs. 

Oleate  of  Bisviiith  is  prepared  by  first  obtaining  crystallized 
bismuth  nitrate,  and  dissolving  it  in  glycerine  and  decompos- 
ing with  this  the  sodium  oleate.  It  is  of  the  consistence  of 
ointment,  and  of  a  pearly-gray  color  and  a  soft,  bland  sub- 
stance. It  has  an  emollient  and  somewhat  astringent  action, 
and  is  an  excellent  application  for  relieving  cutaneous  irritation. 
In  pustular  eruptions,  especially  sycosis,  it  is  a  useful  applica- 
tion ;  also  in  superficial  erysipelas,  sunburn  and  chronic 
inflammation  of  a  portion  of  the  face. 

Oleate  of  Copper  is  prepared  in  a  similar  way  to  the  oleate 
of  lead,  by  double  decomposition  with  a  saturated  solution  of 
copper  sulphate.  A  ten  or  twenty  per  cent,  ointment  can  be 
made  with  either  cosmolinCj  fat  or  lard.  When  applied  to  the 
unbroken  skin,  it  penetrates  deeply,  and  causes  a  slight  stimu- 
lation ;  and  when  applied  to  broken  skin,  it  coats  it  with  an 
insoluble  albuminate.  It  is  very  efficient  for  ringworm,  and 
in  the  most  obstinate  cases  usually  effects  a  cure.  It  is  also 
used  with  advantage  on  indolent  ulcerated  surfaces,  and  with 
effect  on  hard,  horny  warts  and  corns. 

Oleate  of  Arsenic  is  obtained  from  arsenious  chloride,  made 
by  the  careful  saturation  of  hydrochloric  acid  with  arsenic. 
This  solution  is  mixed  with  sodium  oleate,  when  the  arsenic 
oleate  is  precipitated.  In  the  proportion  of  gr.  xx  to  an  ounce 
of  fatty  base,  it  forms  oleate  of  arsenic  ointment,  which  is  soft 
and  yellow,  having  no  action  on  the  skin.  When  applied  to 
wounds,  or  ulcerating  surfaces,  it  destroys  the  tissue  to  some 
depth.  It  is  used  in  lupus,  the  ulcerating  variety  of  epithe- 
29 


450  DENTAL  MEDICINE. 


Homa,  and,  after  scraping  the  surface,  to  destroy  warts,  corns, 
old  granulations,  etc.  It  may  be  combined  with  arnica,  opium, 
belladonna  or  hyoscyamus. 

A  number  of  other  oleates  are  in  use,  among  them  Nickel 
oleate,  which  is  a  greenish,  waxy  mass,  used  in  the  form  of  an 
ointment,  containing  from  five  to  fifteen  grains  to  the  ounce 
of  lard,  is  astringent  and  somewhat  escharotic,  and  useful  for 
hard,  horny,  granulating  surfaces ;  Silver  oleate,  a  brownish 
pulverent  substance,  and,  in  the  form  of  ointment,  valuable 
for  application  to  ulcers,  erysipelas,  etc. ;  Cadmium  oleate,  a 
yellowish-white  mass,  and  in  the  form  of  ointment  (five  to 
fifteen  grains  to  the  ounce),  has  an  astringent  and  escharotic 
action,  and  is  useful  in  glandular  enlargements  and  thickening 
of  the  integument. 

OLEUM  AMYGDALA  DULCIS— OIL  OF  SWEET  ALMONDS. 

Derivation. — The  Oil  of  Sweet  Almonds  is  obtained  by  first 
depriving  the  almonds  of  the  brown  powder  adhering  to  their 
surface,  and  rubbing  them  together  in  a  piece  of  coarse  linen, 
then  grinding  in  a  mill  or  mortar,  and  then  submitting  them 
to  pressure  in  canvas  sacks  between  slightly  heated  plates  of 
iron.  The  oil,  which  is  at  first  turbid,  is  clarified  by  rest  and 
filtration.  It  is  clear,  colorless,  or  of  a  slight  greenish-yellow 
tinge,  nearly  inodorous,  with  a  bland,  sweetish  taste.  It  will 
remain  liquid  at  temperatures  below  the  freezing  point  of  water. 

Medical  Properties  and  Action. — The  oil  of  sweet  almonds 
is  demulcent. 

Therapeutic  Uses. — It  is  employed  as  an  emulsion  in  pul- 
monary affections  with  cough,  and  as  a  vehicle  for  other  medi- 
cines. 

Dental  Uses. — The  oil  of  sweet  almonds  forms  a  pleasant 
and  soothing  application  for  excoriations  of  the  lips  and  in- 
flamed mucous  membranes  ;  also  for  a  soothing  application  to 
the  small,  simple,  but  painful  ulcers  which  sometimes  appear 
upon  the  gums,  mucous  membrane  of  the  cheeks,  and  the 
tongue.  Almond  mixture — Mistura  Amygdaloe — is  made  by 
dissolving  a  mixture  of  half  an  ounce  of  blanched  sweet  al- 


OIL   OF   CLOVES.  45I 


monds,  30  grains  of  gum  Arabic  and   120  grains  of  sugar,  in 
half  a  pint  of  distilled  water.     It  forms  a  pleasant  demulcent. 

OLEUM  CAJUPUTI— OIL  OF  CAJUPUT. 

Source. — The  volatile  oil  of  the  leaves  of  melaleuca  caju- 
puti,  a  tree  indigenous  in  Batavia  and  Singapore.  It  is  trans- 
parent, of  a  green  color,  with  an  odor  like  camphor,  and  a 
warm,  pungent  taste. 

Medical  Pj'operties  mid  Action. — Cajuput  Oil  is  a  diffusible 
stimulant,  antispasmodic  and  diaphoretic.  Internally  adminis- 
tered it  causes  a  sensation  of  warmth  in  the  stomach,  and  ex- 
cites the  action  of  the  heart  and  arteries,  afterward  producing 
copious  diaphoresis.  Externally,  either  alone  or  in  combina- 
tion with  equal  parts  of  soap  liniment  or  olive  oil,  it  is  an  ef- 
ficient rubefacient  and  stimulant  embrocation.  Its  use  is  be- 
coming more  common. 

Therapeutic  Uses. — It  is  employed  internally  as  an  anti- 
spasmodic stimulant  in  typhus  and  other  low  fevers,  spasmodic 
cholera,  gout  and  rheumatism,  neuralgic  affections,  hysteria, 
flatulence  and  flatulent  colic,  headache,  nausea,  etc.  Exter- 
nally, in  neuralgia,  headache,  gout,  rheumatism,  lumbago, 
sprains,  contusions,  paralysis,  etc.,  etc. 

Dose. — Of  cajuput  oil,  gtt.  j  to  gtt.  v,  in  emulsion,  or  on 
sugar. 

Dental  Uses. — Cajuput  oil  is  an  efficacious  remedy  for  the 
relief  of  odontalgia,  applied  on  lint  or  cotton  to  the  carious 
cavity  of  the  tooth  ;  also  in  neuralgic  affections,  if  they  are  not 
connected  with  inflammatory  action. 

OLEUM  CARYOPHYLLI— OIL  OF  CLOVES. 

Source. — Oil  of  Cloves  is  obtained  from  the  dried  flower 
buds  of  the  caryophyllus  aromaticus,  an  evergreen  tree,  of  the 
natural  order  Myrtacea — myrtle  order — a  native  of  the  Indies. 
The  unexpanded  buds  are  of  a  dark- brown  color,  with  a  yel- 
lowish red  tint. 

The  oil  is  prepared  by  distilling  cloves  with  water,  to  which 


452  DENTAL  MEDICINE. 


common  salt  is  added,  in  order  to  raise  the  temperature  to  the 
boihng  point.     It  has  a  fragrant  odor,  and  a  hot,  acrid  taste. 

Medical  Properties  and  Action. — Oil  of  cloves  contains  tan- 
nic acid,  a  pungent,  volatile  oil,  resin,  etc.,  and  two  substances 
— a  hydro-carbon,  caryophjllin,  and  an  oxygenated  oil,  eiigenol, 
called  an  acid  on  account  of  its  possessing  acid  properties. 
Oil  of  cloves  is  an  aromatic  and  powerful  stimulant.  Although 
it  is  a  very  fluid,  clear  and  colorless  preparation  when  fresh, 
it  becomes  yellow  by  exposure,  and  ultimately  reddish-brown, 
with  the  odor  of  cloves,  and  a  hot,  aromatic  taste.  Like 
cloves,  the  oil  acts  less  upon  the  system  at  large  than  on  the 
part  to  which  it  is  immediately  applied. 

Therapeutic  Uses. — Oil  of  cloves  is  sometimes  administered 
to  relieve  nausea  and  vomiting,  to  correct  flatulence  and  excite 
digestion  when  languid ;  but  its  chief  use  is  to  modify  the 
action  of  other  medicines. 

Dose.— Oi  oW  of  cloves,  gtt.  ij  to  gtt.  vj. 

Dental  Uses. — In  dental  practice,  oil  of  cloves  is  employed 
to  relieve  odontalgia,  either  alone,  as  in  the  form  of  a  drop  or 
two  upon  cotton,  introduced  into  the  carious  cavity  of  a  tooth, 
and  obtunds  the  pain  by  an  over-stimulating  effect  upon  the 
irritable  pulp.  It  is  also  employed  for  the  same  purpose  in 
combination  with  other  agents,  such  as  morphia,  sweet  spirits 
of  nitre,  etc.  When  the  use  of  creasote  or  carbolic  acid  is 
prohibited,  owing  to  the  patient's  idiosyncrasy,  the  oil  of 
cloves  may  be  substituted. 

The  oil  of  cloves  has  also  the  effect  of  rendering  creasote 
and  carbolic  acid  more  pleasant,  without  interfering  with  their 
action,  being  added  in  equal  admixture.  It  is  also  employed 
in  the  treatment  of  alveolar  abscess,  putrid  pulps,  being  applied 
like  creasote  or  carbolic  acid,  or  combined  with  other  agents. 

Eugenol,  QoHiaOj,  also  called  eugenic  acid,  is  an  active  prin- 
ciple of  oil  of  cloves,  and  is  prepared  by  decomposing  eugenate 
of  potassium  with  sulphuric  acid.  It  is  in  the  form  of  a  color- 
less oil,  of  the  specific  gravity  of  1.076.  Its  odor  resembles 
that  of  oil  of  cloves,  and  has  a  sharp,  penetrating  taste.  It 
does    not    decompose  at   ordinary  temperatures,  and    is   not 


COD-LIVER   OIL.  453 


affected  by  exposure  to  the  air.  It  is  soluble  in  water  and 
alcohol,  but  the  aqueous  solution  is  the  more  potent  as  a 
germicide.  It  is  not  poisonous,  and  when  pure  will  coagulate 
albumen.  For  dental  uses  eugenol  is  of  considerable  value. 
When  applied  to  exposed  or  partially  exposed  pulps  of  teeth 
it  usually  relieves  the  pain  in  from  one  to  two  minutes.  For 
inflamed  and  congested  pulps,  it  has  been  suggested  to  first 
apply  a  solution  of  borax  and  then  eugenol.  It  also  answers 
well  as  a  dressing  for  root  canals,  especially  after  the  removal 
of  a  recently  devitalized  pulp.  In  alveolar  pyorrhoea,  it  is  used 
in  solution,  i  part  of  eugenol  to  looo  of  water,  for  the  purpose 
of  cleansing  the  pus  pockets.  In  alveolar  abscesses  it  has 
been  suggested  as  an  injection,  after  the  use  of  peroxide  of 
hydrogen,  taking  the  precaution,  in  cases  of  abscesses  with  a 
fistulous  tract,  to  seal  the  root  at  the  apex.  It  has  also  been 
successfully  employed  in  the  treatment  of  benign  tumors  of 
the  mouth,  in  the  form  of  an  injection  of  two  drops. 

OLEUM  MORRHU^E— COD-LIVER  OIL. 

Source. — Cod-liver  oil  is  obtained  from  the  liver  of  the  cod, 
Gadiis  viorrfmcB,  and  is  in  the  form  of  a  fixed  oil,  containing 
biliary  principles,  traces  of  iodine,  bromine,  phosphorus,  lime, 
magnesia,  iron,  soda  and  sulphuric  and  phosphoric  acids ;  also 
a  principle  known  as  gadidn.  By  distillation  with  ammonia,  it 
yields  propylamin.  The  pale  oil  is  considered  to  be  the  best 
for  internal  use,  and  is  the  official  preparation.  Iodine,  phos- 
phorus, bromine  and  iron  are  often  combined  with  cod-liver  oil, 
but  are  considered  to  add  nothing  to  its  therapeutical  powers. 
The  special  medicinal  value  of  this  oil  depends  upon  the 
gaduin  and  propylamin,  which  are  constituents  of  bile,  igdine, 
phosphorus,  bromine,  etc.,  as  well  as  upon  the  common  ingre- 
dients of  animal  fat.  The  phosphates,  hypo-phosphites,  or  the 
lacto-phosphate  of  lime  are  often  combined  with  cod-liver  oil, 
with  excellent  effects. 

Medical  Properties  and  Therapeutic  Uses. — Cod-liver  oil  is 
considered  to  be  a  valuable  remedy  in  certain  forms  of  phthisis, 
such  as  the  chronic  forms, — chronic  tuberculosis  and  fibroid 


454  DENTAL  MEDICINE. 


lung;  but  not  in  acute  phthisis  and  caseous  pneumonia;  also 
in  chronic  afifections  of  the  brain  and  nervous  system,  and 
such  skin  diseases  as  lupus,  ecthyma,  psoriasis,  etc.  It  is  also 
employed  in  sequelae  of  scarlet  fever,  chronic  bronchitis,  em- 
physema, chronic  rheumatism  and  rheumatic  arthritis,  strumous 
synovitis,  scrofula,  caries  and  necrosis  of  bone,  scrofulous, 
rickety  infants  and  chlorotic  girls  derive  benefit  from  warm 
baths  and  inunctions  of  the  oil ;  also  lean  persons.  Inunc- 
tion with  cod-liver  oil  is  also  useful  in  rubeola,  scarlatina,  ery- 
sipelas, high  fevers,  catarrhal  attacks,  scrofula,  phthisis,  chronic 
dysentery,  etc.  It  builds  up  the  tissues,  repairs  waste  and 
supplies  nervous,  muscular  and  digestive  power.  It  may  be 
administered  in  ale,  beer,  coffee,  lemon  juice,  hot  whiskey 
punch,  compound  spirits  of  lavender  and  brandy,  or  washing 
out  the  mouth  with  whiskey  or  brandy,  or  as  an  emulsion 
made  with  glycerine  and  yolks  of  eggs,  and  flavored.  It  is 
also  used  in  the  preparation  of  bread  in  form  of  rolls ;  ether 
added  to  it  promotes  its  digestion  ;  fifteen  minims  of  ether  to 
every  half-ounce  of  the  oil. 

Dose. — Of  cod-liver  oil,  f  5j  to  5iv 

OPIUM. 

Source. — Opium  is  obtained  from  the  unripe  capsules  of  the 
papaversomniferum,  of  the  natural  order  Papaveracece — poppy 
order,  in  the  form  of  a  concrete  juice,  which  exudes  from  in- 
cisions, and  which  is  permitted  to  evaporate  spontaneously. 
Commercial  opium  is  in  the  form  of  irregular  masses,  of  from 
a  few  ounces  to  several  pounds  in  weight,  with  a  moist,  brown 
or  chestnut  surface,  and  a  peculiar  odor  and  nauseous  taste. 
The  purest  form  should,  have  a  chestnut  color,  a  strong  aro- 
matic flavor,  and  a  dense  consistence,  and  break  with  a  deeply 
notched  fracture,  and  when  drawn  across  white  paper  leave  an 
uninterrupted  line.  The  alkaloid  morphine  is  the  most  impor- 
tant of  the  chemical  constituents  of  opium.     (See  Morphine). 

Medical  Properties  and  Uses. — As  an  anodyne  and  hypnotic 
opium  possesses  the  power  of  relieving  pain  and  inducing 
sleep  ;  it  relaxes  muscular  .spasm,  and  hence  is  a  very  efficient 


OPIUM.  455 

remedy  in  tetanus,  spasms,  nervous  irritability  and  discharges 
of  a  morbid  nature.  It  excites  the  circulation  as  a  first  action, 
and  increases  the  temperature  of  the  skin,  and  causes  an  agree- 
able exhilaration  of  the  intellectual  faculties,  so  much  so  as  to 
be  used  by  some  as  an  habitual  narcotic,  which  is  finally  de- 
structive to  both  the  physical  and  mental  functions.  But  the 
stage  of  excitement  is  very  transient,  and  is  succeeded  by  a 
falling  of  the  pulse,  a  diminished  susceptibility  to  external 
impressions,  confusion  of  mind  and  the  loss  of  consciousness 
in  deep  sleep.  Other  effects  are  also  manifested,  such  as  dry- 
ness of  the  throat,  thirst,  and,  in  some  cases,  nausea  and 
vomiting,  with  an  itching  miliary  eruption  on  the  skin. 

Taken  in  large  or  poisonous  doses,  opium  does  not  cause 
any  excitement,  but  giddiness  and  stupor  rapidly  supervene, 
with  a  lessening  in  the  frequency  of  the  pulse,  but  not  in 
fullness,  a  tendency  to  sleep,  which  is  irresistible,  and  finally 
coma,  in  which  the  breathing  is  heavy  and  stertorous,  the 
pulse  slow,  and  the  pupils  contracted,  with  a  sinking  of  the 
pulse  and  relaxation  of  the  muscles  immediately  preceding 
death ;  in  the  case  of  children  death  is  often  preceded  by 
violent  convulsions. 

The  antidotes  in  poisoning  by  opium  are  the  stomach  pump, 
emetics  in  double  doses,  such  as  sulphate  of  zinc,  in  doses  of 
gr.  XX  to  gr.  XXX,  or  sulphate  of  copper,  gr.  v  to  gr.  x ;  also 
mustard  in  powder,  5ss,  or  powdered  alum,  answer  as  emetics, 
strong  coffee,  keeping  the  patient  in  motion,  counter-irritation 
to  nape  of  neck,  flagellation  to  the  palms  of  the  hands  and 
soles  of  the  feet,  and  the  electro-magnetic  battery,  which  is 
often  efficient  when  other  measures  fail,  artificial  respiration, 
and  belladonna,  in  hypodermic  injections  of  its  alkaloid  atro- 
pine, in  solution.     No  local  lesions  are  found  after  death. 

Therapeutic  Uses. —  Opium  as  an  anodyne  and  hypnotic  is 
employed  in  almost  all  diseases  where  the  necessity  of  assua- 
ging pain  and  inducing  sleep  is  required.  (See  Morphine). 
Opium  is  contra-indicated  where  there  is  a  tendency  to  apo- 
plexy or  coma,  or  where  an  unusual  susceptibility  to  its  in- 
fluence exists,  and  it  should  be  administered  to  the  very  young 


456  DENTAL   MEDICINE. 


and  very  old  with  great  caution.  When  long  administered  it 
is  necessary  to  increase  the  dose.  Externally,  in  the  form  of 
powder,  it  is  applied  to  irritable  ulcers,  etc.,  and  to  the  rectum, 
as  suppositories. 

Dose. — Of  opium,  in  powder  or  pill,  as  an  anodyne  and  hyp- 
notic, gr.  j. 

Dental  Uses. — Opium  is  employed  as  an  anodyne  in  con- 
vulsions of  teething,  but  must  be  administered  with  great  care 
and  in  small  doses  ;  also  as  an  anodyne  preparatory  to  lancing 
the  gums  of  children ;  also  in  mercurial  salivation,  to  arrest 
the  excessive  secretion,  in  doses  of  gr.  j  every  four  hours ; 
also  in  neuralgia;  but  it  is  inferior  to  aconite.  A  small  lump 
of  opium  in  contact  with  an  aching  tooth  pulp  will  relieve  the 
pain,  or  the  powder  may  be  used  for  the  same  purpose.  In  the 
form  of  wine  and  tincture,  opium  is  serviceable  in  odontalgia, 
periodontitis,  inflamed  gums  and  mucous  membrane  of  the 
mouth ;  in  injections,  for  alveolar  abscess,  when  it  is  often 
used  in  combination  with  tincture  of  iodine.  The  wine  of 
opium  is  a  more  soothing  and  pleasant  application  than  the 
tincture  of  opium. 

ViNUM  Opii — Wine  of  Opiinn,  is  obtained  by  macerating 
two  ounces  of  powdered  opium,  together  with  cinnamon  and 
cloves,  in  one  pint  of  white  wine.     Dose,  TTtv  to  5j. 

Dental  Uses — Employed  as  a  soothing  and  anodyne  appli- 
cation to  inflamed  and  tender  gums  and  mucous  membrane, 
odontalgia,  ulcerations  of  mouth,  alveolar  abscess,  periodon- 
titis, pulpitis,  etc.  Dr.  W.  H.  Atkinson  recommended  wine 
of  opium  by  means  of  injection,  into  pockets  and  cavities, 
where  such  exist,  in  cases  of  aching  gums  or  teeth. 

Dover's  Powder — Pulvis  ipecacuanhcs  et  opii.  Dose,  gr.  x. 
Ten  grains  contain  one  grain  each  of  ipecac  and  of  opium,  and 
eight  grains  of  sugar  of  milk.  For  influenza  or  "  common 
cold,"  a  dose  of  Dover's  powder  taken  at  bed-time,  with  such 
adjuncts  as  warm  clothing,  hot  drinks,  foot-baths,  etc.,  to  pro- 
mote profuse  diaphoresis,  proves  very  effective.  Ten  grains 
at  bed-time  is  also  a  very  serviceable  remedy  for  inflammations 
of  the  peridental  membrane. 


OPIUM.  457 

TiNCTURA  Opii — Tincture  of  Ophun — laudanum,  is  composed 
of  powdered  opium,  Siiss  ;  diluted  alcohol,  Oj.  Dose,  Tllv  to 
TTLxxx;  25  drops  are  equivalent  to  one  grain  of  opium.  Its 
strength  increases  with  age.  Tincture  of  opium  in  hot  water 
(f5ij,  to  aquae  ferv.  fox),  held  for  some  minutes  in  the  mouth, 
is  useful  in  peridental  inflammation. 

One  drachm  of  the  tincture  contains  120  drops.  The  dental 
uses  are  the  same  as  for  wine  of  opium,  but  the  latter  is  the 
most  pleasant  application  for  the  mouth. 

TiNCTURA  Opii  Camphorata — Camphorated  Tincture  of 
Opium — paregoric  elixir — is  prepared  by  macerating  sixty 
grains  of  opium  in  two  pints  of  diluted  alcohol,  with  sixty 
grains  of  benzoic  acid,  a  fluidrachm  of  oil  of  anise,  two  ounces 
of  clarified  honey,  and  forty  grains  of  camphor.  Dose,  foj  to 
f.5J  or  a  tablespoonful,  containing  a  little  less  than  one  grain  of 
opium.  Dose  for  an  infant,  gtt.  v.  to  xx.  This  is  an  agreeable 
preparation  for  children. 

TiNCTURA  Opii  Deodorata — Deodorized  Tincture  of  Opium 
— is  composed  of  the  watery  extract  of  opium,  washed  with 
ether,  which  is  afterward  separated,  and  the  residue  dissolved 
in  water  and  mixed  with  enough  alcohol  to  preserve  it.  This 
preparation  of  opium  is  free  from  the  narcotina  and  many 
other  injurious  ingredients  of  opium,  and  is  a  valuable  prep- 
aration.    Dose,  TTLv  to  ULxxx. 

DENTAL    FORMULA. 
A    Stimulating    Injection  for   Abscess       sodium  or  of  potassium  with  anise,  cin- 
of  Antrum.  namon,  or  caraway,  with   each   meal. 

T.   S.  Smith.  ^^  undigested   food   or  vitiated  secre- 

T,       ^^^         ■                            cT-  tions  in  alimentary  tract  are  suspected, 

iSc.    Glycermas f5j  .                       . 

~.     ^        ..           ,            ,_..  a  dose  of  castor  oil  and  aromatic  syrup 

Imct.  opn  camph.  .    .131J  .                       . 

T^        ,        ,                            .  ,,        of   rhubarb  in  equal  portions — dose,  a 

Eau  de  cologne  .    .    .     siv.  M.                                   -1        r 

o                T   ■     t  d   ■]  teaspoonful ;  if  torpidity  of  liver,  a  few 

doses  at  intervals  of  two  hours,  of  the 

J^or  hifantile  Diarrhcea  During  Deti-       .      ir..  •  ..       ..u       r  •         c 

J  .  .  -^  twelfth    or    sixteenth    of    a    grain    of 

calomel    with    one    or    two    grains    of 

When  there  is  a  tendency  to  an  acid  ,•         v      u       .         tc  ..t,     j-„„u^„ 

-'  sodium  bicarbonate,     if  the  diarrhcea 

fermentation  of  the  food.  •  ,  .i      <•  u  „„• c^f    „,,^ 

persists,  use   the   following,   nrst   pro- 

Dr.  Jas.  W.  White.  hibiting  the  use  of  farinaceous  or  milk 

First  give  a  grain  of  bicarbonate  of      food: 


458  DENTAL  MEDICINE. 


continued 

warm 

weather 

1   or 

foUow- 

ing 

cholera 

infantum,  and 

no 

fever  is 

present. 

Dr, 

.    JAS. 

W.  White. 

li. 

Tinct. 

opii 

camph.    . 

f^J 

Ext.  hsematoxyli    .    . 

gr.xvj 

Mist  cretae 

Aquffi 

cinnamomi  .  aa 

f§j 

M. 

R.    Tinct.  opii gtt.viij 

Bismuth  subnitrat.  .    .     ^j 
Mucilag.  acaciee  .    .    .  f^ss 
Aquse  menth.  pip.  .    .  f  ^  iss.      M. 
SiGNA. — A  teaspoonful    every  3  hours 
to  a  child  6  months  old.     Opium  is 
indicated    only    after    all    offending 
matters  have  been  expelled  from  the 
alimentary  canal. 

For  Infantile  Diarrhcea  Dto'ing  Den- 

titioit.  SiGNA. — A  teaspoonful  in  water  every 

If  it  is  due  to  relaxation  from  long  4  hours  for  a  child  6  months  old. 

OXYQUINASEPTOL— DIAPHTHERIN. 

/^^r;;//^/«.  — HO— CgHgNH— O— SO2— CgH,— O— NHCgHg 
—OH. 

Derivation. — Oxyquinaseptol  is  a  union  of  two  molecules  of 
oxyquinolin  and  one  molecule  of  aseptol,  i.  e.,  phenolsulfonic 
acid. 

Medical  Properties  and  Uses. — Oxyquinaseptol  is  an  ener- 
getic antiseptic,  having  little  or  no  caustic  action.  Three 
per  cent,  solutions  possess  anti-bacterial  properties,  and  one 
per  cent,  solutions  are  sufficient  for  the  treatment  of  wounds, 
as  it  is  the  least  poisonous  of  antiseptics.  It  is  preferred  by 
Kronacher  and  Brandt  to  carbolic  acid  or  sublimate  on  account 
of  its  extreme  antiseptic  properties  in  small  concentrations, 
and  because  of  its  insignificant  toxic  effects.  It  is  prescribed 
in  powder  or  pill  form,  and  in  thirty  to  fifty  per  cent,  solutions. 

Oxyquinaseptol,  in  the  non-precipitated  form,  is  of  a  yellow- 
ish sulphur  color,  with  a  slight  phenol  odor,  while  the  precipi- 
tate is  white. 

Dental  Uses. — As  an  antiseptic  in  all  affections  requiring 
antisepsis,  such  as  putrescent  pulps,  abscess,  fistulous  open- 
ings, suppuration  from  necrosis  of  maxillary  bones.  Dr.  Brandt, 
of  Berlin,  asserts  that  at  the  present  time  no  antiseptic 
material  exists  which  is  more  valuable  for  like  cases  than 
diaphtherin. 

PAPAIN  OR  PAPAIVA. 

Source. — Papain    is   a   ferment    obtained   from   the    Carica 


PARALDEHYDE.  459 


papaya,  from  which  exudes,  on  incision,  a  white,  slightly- 
astringent  and  milky  juice,  which  contains  the  papain. 

Medical  Properties  and  Action. — Papain  is  a  digestive  fer- 
ment like  pepsin,  its  active  digestive  power  causing  the  solu- 
tion of  albuminous  substances.  Catillon  denies  that  it  is  a 
true  ferment,  with  power  to  convert  albuminoids  into  peptones; 
hence  it  cannot  be  substituted  for  pepsin  in  affections  of  the 
stomach. 

Therapeutic  Uses. — It  is  an  active  solvent  of  false  mem- 
branes, intestinal  worms,  ascarides  and  taenias,  hence  it  is 
employed  in  diphtheria,  ascarides,  vermiculares,  tapeworm. 
Locally,  like  pepsin,  it  is  employed  in  the  form  of  injections 
made  with  the  hypodermic  syringe,  in  the  treatment  of  fatty 
tumors  and  other  benign  growths,  and  to  retard  the  growth 
of  cancerous  and  other  malignant  tumors,  the  solution  being 
injected  well  into  the  substance  of  the  tumor. 

Dental  Uses.  —  Papain  is  employed  in  the  treatment  of 
tumors  of  the  mouth,  both  benign  and  malignant,  the  solution 
being  injected  into  the  substance  of  the  growth  by  means  of  a 
hypodermic  syringe. 

PARALDEHYDE— PARALDEHYDE. 

Formula. — C6Hi203^3C2H40. 

Derivation. — Paraldehyde  is  a  polymeric  modification  of 
aldehyde  (C2H4O).  It  is  a  colorless  liquid  of  an  ethereal  odor, 
pungent  taste  and  insoluble  in  eight  parts  of  water,  which 
is  a  proper  menstruum.  It  is  frequently  combined  with 
chloroform,  oil  of  almonds  and  syrup  of  orange-peel,  or 
cinnamon. 

Medical  Properties  and  Therapeutic  Uses. — Paraldehyde  is 
an  efficient  hypnotic,  similar  in  its  effects  to  chloral,  although 
the  sleep  caused  by  it  is  not  so  deep  nor  so  prolonged.  As 
it  does  not  weaken  or  paralyze  the  heart  or  lungs,  it  is  con- 
sidered to  be  safer  than  chloral.  It  is  employed  as  a  hypnotic 
in  fevers,  rheumatism,  gout,  prurigo,  insomnia,  hysterics,  de- 
lirium tremens,  some  cases  of  neuralgia,  and  all  mental  and 
nervous    disorders.      It    is    also    used    as    an    expectorant. 


460  DENTAL  MEDICINE. 


Poisonous  doses  cause  respiratory  paralysis.     The  action  of 
paraldehyde  upon  digestion  is  as  follows  : 

a.  Large  quantities  considerably  accelerated  the  digestion 
of  fibrin,  and  that  the  rate  of  this  acceleration  was  distinctly 
in  ratio  with  the  quantity  used. 

b.  Small  quantities  also  increased,  but  to  a  less  degree,  the 
digestion  of  fibrin. 

c.  Putrefaction  was  prevented  by  the  larger  quantities  of 
paraldehyde,  and  was  delayed  by  the  smaller  quantities. 

Dose. — Of  Paraldehyde,  TTLxv  to  f5j,  repeated  if  necessary. 

PENTAL— TRI-METHYL-ETHYLENE. 

Formula. — (CH2)2-C:CH.C.H3. 

Derivation. — Pental  is  a  tertiary  amylene,  obtained  by  heat- 
ing amylene  hydrate  in  presence  of  acids.  It  is  a  colorless 
liquid  of  specific  gravity  0.6783  at  32°  F.,  insoluble  in  water, 
but  soluble  in  all  proportions  with  alcohol,  chloroform  and 
ether.  It  is  as  inflammable  as  ether,  and  should  therefore  not 
be  exposed  to  a  flame.  It  boils  at  100.4°  F.,  or  the  latest  prep- 
aration at  38°  C,  and  burns  with  a  luminous  flame,  and  has 
a  penetrating  odor  like  that  of  mustard-oil. 

Medical  Properties  and  Action. — Pental  is  a  general  anaes- 
thetic and  has  been  recommended  by  Dr.  Hollander,  of  Halle, 
for  minor  surgical  operations  on  account  of  no  untoward  effect 
being  produced  by  it  upon  the  tissues  of  the  mouth  and 
respiratory  passages ;  that  unpleasant  after-effects  are  excep- 
tional ;  that  consisting  only  of  carbon  and  hydrogen,  to  the 
exclusion  of  the  halogens,  it  therefore  produces  no  evil 
after-effects.  It  is  also  claimed  for  pental  that  the  anaesthesia 
comes  on  gradually  without  any  previous  conspicuous  symp- 
toms whatever ;  that  the  quickened  pulse  at  the  beginning  soon 
returns  to  its  normal  state,  and,  notwithstanding  that  the  sen- 
sibility vanishes,  consciousness  in  most  cases  partially  remains. 
Under  the  profoundest  narcosis  from  pental,  it  is  asserted, 
that  patients  when  requested  will  open  the  jaws,  even  though 
they  were  firmly  closed  before,  and  although  they  look  at  the 
operator  with  wide-open  eyes,  still  they  are  unaware  of  what 


ETHYLENE.  461 


is  being  done  with  them.  During  the  anaesthesia  from  pental 
and  after,  no  disagreeable  feeHng,  such  as  nausea,  headache, 
etc.,  occurred  in  the  experience  of  Dr.  Hollander;  and  he 
claims  that  he  never  noticed  any  contraction  of  the  muscles  of 
the  jaws  and  fingers,  as  is  the  case  under  bromide  of  ether, 
nor  any  depression  of  the  chest  or  syncope,  which  sometimes 
result  from  chloroform  and  bromide  of  ethyl.  He  also  asserts 
that  he  has  administered  pental  to  children  from  four  to  ten 
years  of  age,  and  to  old  people  from  fifty  to  sixty  with  the 
same  results,  and  the  least  stage  of  excitement  is  very  uncom- 
mon, the  patient  being  always  animated  in  a  friendly,  cheerful 
way,  so  that  it  could  be  termed  laughing-ether.  It  is  also 
claimed  that  pental  anaesthesia  differs  from  chloroform  in  that 
it  takes  place  more  rapidly,  and  that  there  is  no  effect  upon 
the  action  of  the  heart  or  respiration,  and  the  administration 
in  large  quantities  appears  to  be  absolutely  free  from  danger. 
Narcosis  is  produced  by  pental  in  from  40  to  45  seconds,  and 
the  rules  and  precautions  in  administering  it  are  the  same  as 
for  all  other  ansesthetics.  Nervous  and  infirm  patients  require 
more  of  pental  than  the  robust;  and  it  is  not  always  possible 
to  determine  when  the  anaesthesia  is  complete,  as  the  corneal 
reflex  remains  somewhat  long;  and  even  though  the  raised 
hand  should  not  fall  back  powerless,  the  anaesthesia  may  have 
occurred.  Drs.  H.  C.  Wood  and  D.  Cerna,  however,  from 
experiments  made  with  pental,  arrived  at  the  conclusion  that 
pental  will  probably  prove  to  be  a  dangerous  anaesthetic,  and 
if  extensively  used  will  produce  death  by  cardiac  arrest ;  and 
they  also  say  that  it  is  probable  that  the  after-effects  in  the 
human  being  would  be  disagreeable,  as  they  noticed  in  a  dog 
a  peculiar  wild  excitement  directly  after  the  anaesthesia  had 
passed  off.  Pental  is  best  administered  by  means  of  Junker's 
inhaler,  which  also  weakens  its  unpleasant  odor;  other  appar- 
atus occasion  too  much  loss,  as  it  is  very  volatile,  and  consume 
more  time.  When  taken  up  by  the  blood,  pental  is  separated 
into  two  substances — water  and  carbonic  acid.  All  apparel 
which  impedes  free  breathing  should  be  removed  during  the 
administration  of  pental,  and  the  room  be  somewhat  darkened. 


462  DENTAL  MEDICINE. 


Dental  Uses. — Pental  is  employed  as  a  general  anaesthetic 
in  dental  practice,  principally  for  the  extraction  of  teeth,  and 
Dr.  Hollander  claims  that  in  the  case  of  a  single  extraction  it 
is  not  necessary  to  wait  for  the  disappearance  of  the  corneal 
reflect,  as  it  sometimes  occurs  rapidly,  and  at  other  times  very 
slowly;  and  that  the  narcosis,  although  somewhat  slower  than 
bromide  of  ethyl,  lasts  longer,  the  duration  being  from  three  to 
seven  minutes,  and  the  time  for  its  production  one-half  to  two 
minutes.  Dr.  Hollander  also  claims  that  pental  has  produced 
anaesthesia  when  several  other  prominent  agents  have  failed  ; 
but  from  the  fact  that  unpleasant  incidents  have  occurred 
during  its  use  it  should  be  very  carefully  administered. 

PEPSINUM— PEPSIN. 

Source. — Pepsin  is  obtained  by  digesting  the  mucous  mem- 
brane of  the  stomach  of  the  pig,  calf  or  sheep,  which  has  been 
scraped  off,  chopped  finely,  and  macerated  for  several  days  in 
water,  in  a  solution  of  muriatic  acid,  from  which  the  pepsin  is 
precipitated  with  chloride  of  sodium.  The  medicinal  preparation 
is  in  the  form  of  a  nitrogenized,  light,  amorphous,  grayish-white 
or  fawn-colored  powder,  soluble  in  water  and  alcohol,  and  of  a 
peculiar  odor,  and  bitter,  nauseous  taste.  When  quite  pure,  it  is 
both  tasteless  and  inodorous.  When  decomposed  by  heat  it  no 
longer  possesses  digestive  properties,  and  much  of  what  is  sold 
is  almost  or  wholly  inert.  Pure  pepsin  is  an  artificial  digestive. 

Medical  Properties  and  Action. — Pepsin  is  an  essential  con- 
stituent of  the  gastric  juice,  and  digests  the  nitrogenous  con- 
stituents of  the  food,  converting  them  into  peptones.  Taken 
internally,  as  a  medicinal  preparation,  pepsin  increases  the 
appetite  and  allays  irritability  of  the  stomach.  It  should  be 
administered  immediately  before  meals,  and  no  hot  food  taken 
for  some  time  afterward. 

Therapeutic  Uses. — Pepsin  is  employed  in  dyspepsia,  gas- 
tralgia,  obstinate  vomiting,  infantile  diarrhoea,  apepsia  of 
infants,  vomiting  of  pregnancy,  cancer  and  chronic  ulcer  of 
the  stomach,  anaemia,  chlorosis,  atrophy,  etc.  Externally,  it 
is  injected  into  cancerous  tumors  and  morbid  growths  with 
the  hypodermic  syringe,  to  retard  their  progress. 


PEPSIN.  463 

Dose. — Of  pepsin  suspended  in  syrup,  saccharated  pepsin — 
Pepsinum  saccharatuni  gr.  v.  to  gr.  x.  Syrup  of  orange  peel 
will  disguise  its  odor.  Vimim  Pcpsini.  Dose,  5ss  to  .5j. 
Glycerimun  Pepsini.     Dose,  5ss  to  5j. 

Both  the  saccharated  pepsin  and  the  glycerole  are  un- 
changeable. 

Pepsin  appears  to  be  especially  efficient  in  cases  of  children; 
and  when  pepsin  and  a  small  quantity  of  hydrochloric  acid  are 
added  to  animal  broths  given  by  the  rectum,  in  cases  where  food 
is  rejected  by  the  stomach,  such  nourishment  is  very  beneficial. 

Dental  Uses. — In  dental  practice,  pepsin  is  successfully  em- 
ployed in  the  treatment  of  putrid  pulps  of  teeth,  as  an  anti- 
septic and  deodorizer.  In  the  form  of  a  thin  paste  made  by 
mixing  pepsin  with  water  containing  some  two  per  cent,  of 
hydrochloric  acid,  it  is  introduced  into  the  pulp  canal  after 
the  removal  of  the  decomposed  matter,  and  confined  by  a 
temporary  filling  in  the  crown  cavity,  being  permitted  to  re- 
main for  twenty-four  hours,  when  it  is  removed  and  the  canal 
syringed  with  tepid  water,  and  if  necessary,  the  application  of 
the  pepsin  paste  repeated  until  the  odor  of  decomposition  can 
no  longer  be  detected.  Pepsin,  in  the  form  of  the  paste,  is 
also  applied  to  partially  decomposed  dentine,  which  may,  for 
good  reasons,  be  permitted  to  remain  immediately  over  the 
pulp  of  the  tooth,  and  the  action  of  the  pepsin  is  confined  to 
dead  matter  alone.  The  hydrochloric  acid  and  pepsin  paste 
has  also  been  recommended  for  devitalizing  the  pulps  of  teeth 
where  rapid  action  is  not  desired,  the  quantity  employed  being 
about  one-fifteenth  of  a  grain, 

DENTAL    FORMULAE. 
For  Suppurating  Dental  Pulps.  For  Indigestion. 

Oakley  Coles.  Mialhe. 

R.    Acidi  hydrochlorici    .  1T1J  R.    Pepsini 3;iss 

Aquee  destillatfe  .    .    .  TTLxl  Aquae f  3  viss 

Pepsini  porci  .    .    .    .  q.  s.  Vini  xerici  .....  f^xiiss 

To  make  a  paste.  Alcoholis f5''j 

SiGNA. — To  be  applied  to  suppurating  Sacchari 5J. 

pulps.  SiGNA. — A  tablespoonful    immediately 

after  each  meal. 


464  DENTAL  MEDICINE. 


Ingluvin  is  a  ferment  prepared  from  the  gizzard  of  the 
chicken,  and  its  effects  are  analogous  to  those  of  pepsin.  It 
is  employed  internally  for  indigestion,  etc.,  and  to  prevent 
nausea  and  vomiting. 

Dose. — Of  Ingluvin,  grs.  v  to  3j. 

PEROXIDE  OF  HYDROGEN— HYDROGEN  PEROXIDE. 
HYDROGEN  DIOXIDE. 

Formula. — HjOg. 
-  Derivation. — Peroxide  of  Hydrogen  is  obtained  by  rubbing 
up  peroxide  of  barium  with  distilled  water,  so  as  to  form  a 
liquid  paste,  which  is  added  gradually,  with  constant  stirring, 
to  distilled  water  acidulated  with  one-third  of  its  weight  of 
hydrochloric  acid,  contained  in  a  vessel  immersed  in  a  freezing 
mixture.  When  the  muriatic  acid  is  saturated,  a  fresh  quan- 
tity of  the  acid  in  a  concentrated  state  is  added,  and  then 
more  of  the  peroxide  of  barium,  and  the  operation  repeated 
till  the  solution  will  hold  no  more  chloride  of  barium,  which 
is  deposited  by  a  mixture  of  ice  and  salt,  except  a  small  por- 
tion which  is  gotten  rid  of  by  adding  sulphate  of  silver  to 
precipitate  the  sulphate  of  baryta  and  chloride  of  silver.  The 
filtered  liquid  is  then  concentrated  by  sulphuric  acid,  and  the 
water  rising  in  vapor  is  absorbed  and  protoxide  of  hydrogen 
is  obtained  nearly  pure,  in  the  form  of  a  colorless  liquid  of  a 
fluid  consistence. 

L.  Crismer  explains  a  new  and  economic  process  for  pre- 
paring hydrogen  peroxide.  It  depends  upon  the  long-known 
property  of  sulphuric  ether  of  taking  up  and  dissolving  large 
quantities  of  HgOg.  Commercial  barium  oxide,  containing 
from  85  to  90  per  cent,  of  Ba02  is  treated  with  an  excess  of 
hydrochloric  acid  (i.io  specific  gravity),  and  the  solution 
shaken  up  with  an  equal  volume  of  ether.  The  mixture  is  let 
stand  until  separation  has  taken  place,  when  the  ether  is  drawn 
off  and  agitated  with  distilled  water,  which  latter  removes  and 
takes  up  all  the  hydrogen  peroxide  which  the  ether  held  in 
solution.  The  cleaned  ether  is  separated  from  the  water,  and 
is  again  shaken  with  the  solution  of  barium  oxide,  and  again 


PEROXIDE  OF  HYDROGEN.  465 

extracted  with  the  distilled  water.  The  operation  is  repeated 
five  or  six  times,  by  which  the  extraction  of  H2O2  is  complete. 
The  aqueous  solution  will  then  form  8  to  9  per  cent,  of  the 
peroxide,  and  is  entirely  neutral  and  free  from  solid  matter. 
■  Medical  Properties  and  Action. — Dr.  B.  W.  Richardson,  of 
London,  found  that  peroxide  of  hydrogen  imparts  oxygen  to 
venous  blood  deprived  of  its  fibrin,  with  an  increase  of  heat 
and  a  change  of  the  color  to  red.  Fibrin  and  cellular  tissue 
cause  it  to  evolve  oxygen,  while  albumen,  gelatin,  urea,  and 
cutaneous  tissue  have  no  effect  upon  it. 

Topically,  it  acts  by  imparting  oxygen  to  the  diseased  tis- 
sues, and  thus  destroying  them.  It  arrests,  immediately  and 
definitel)^,  all  fermentation  due  to  an  organized  ferment,  and 
Bert  and  Reynard  found,  on  the  other  hand,  that  soluble 
ferments  do  not  seem  to  be  affected  by  it;  saliva,  diastase,  the 
gastric  and  pancreatic  fluids,  continue  to  act  in  solutions  con- 
taining peroxide  of  hydrogen.  The  conclusions,  therefore, 
that  these,  as  well  as  Peau  and  Baldy,  have  arrived  at  are  that 
peroxide  of  hydrogen,  even  when  very  dilute,  arrests  fermen- 
tation due  to  the  development  of  living  organisms,  and  the 
putrefaction  of  all  substances  which  do  not  decompose  it;  that 
containing,  according  to  circumstances,  from  two  to  six  times 
its  volume  of  oxygen,  it  is  capable  of  advantageously  replacing 
alcohol  and  carbolic  acid ;  that  it  can  be  employed  externally 
for  dressing  wounds  and  ulcerations  of  all  natures,  in  injections 
and  in  vaporizations,  and  internally  ;  that  the  results  obtained 
in  the  case  of  the  largest  operations,  up  to  the  present,  are  in 
the  highest  degree  satisfactory ;  that  not  only  fresh  wounds, 
but  old  ones,  proceed  rapidly  to  cicatrization,  and  reunion  by 
first  intention  appears  to  be  encouraged  by  its  use  as  a  dress- 
ing ;  that  the  general  as  well  as  the  local  state  appears  to  be 
favorably  influenced ;  that  the  advantages  over  carbolized 
water  are  its  not  having  any  poisonous  effect  nor  unpleasant 
odor,  while  its  application  is  entirely  painless.  It  is  an  effective 
application  in  a  large  class  of  diseases  in  which  mucous  mem- 
brane tissue  is  chiefly  affected,  and  for  cleansing  purposes  is 
considered  to  be  unequaled.  Dr.  Prince  remarks  that  a  drop 
30 


466  DENTAL   MEDICINE. 


of  pus  will  decompose  peroxide  of  hydrogen  and  liberate 
nascent  oxygen,  which  adheres  to  and  attacks  all  the  adjacent 
tissues  for  which  it  has  an  affinity,  and  it  thus  becomes  a 
powerful  bacterial  destroyer.  Peroxide  of  hydrogen  for 
surgical  use  must  be  entirely  neutral,  as  that  obtained  gener- 
ally often  contains  sulphuric  acid,  so  that  its  use  would  not  be 
without  danger. 

Therapciitic  Uses. — Peroxide  of  hydrogen  is  employed  as  an 
internal  remedy  in  low  forms  of  fevers,  chronic  and  subacute 
rheumatism,  whooping  cough,  chronic  bronchitis,  dyspepsia, 
as  it  improves  digestion,  diabetes,  etc.,  etc.  Locally  employed, 
peroxide  of  hydrogen  is  an  effective  antiseptic,  and,  according 
to  Dr.  Prince,  owes  its  importance  as  a  therapeutic  agent  to  its 
instability,  being  decomposed,  in  the  presence  of  a  variety  of 
agents,  into  water  and  oxygen.  He  considers  peroxide  of 
hydrogen  to  be  inferior  to  iodoform  as  an  antiseptic,  bat  it 
resembles  it  in  producing  little  or  no  irritation  when  used 
about  tender  organs,  and  can  be  successfully  applied  in  an 
unirritating  form,  so  that  it  comes  in  contact  with  and  destroys 
diseased  germs ;  hence  its  applicability  to  dental  uses,  and  in 
ocular  and  oral  therapeutics,  as  in  gonorrhoeal  ophthalmia  and 
mastoid  abscess,  for  example.  Peroxide  of  hydrogen  acts 
very  promptly  and  beneficially  in  feeble,  flabby,  or  ill-condi- 
tioned ulcers,  chancre,  and  diphtheritic  sores,  ozaena,  wounds, 
both  fresh  and  putrid,  etc.,  etc.  Peroxide  of  hydrogen  appears 
to  have  no  injurious  effect  upon  animal  cells,  but  has  a  very 
energetic  destructive  action  upon  vegetable  cells — microbes. 
It  has  no  toxic  properties,  and  is  also  harmless  when  given  by 
the  mouth.  It  is  especially  applicable  in  the  treatment  of 
diseases  caused  by  germs  if  the  microbian  element  is  directly 
accessible,  and  is  particularly  useful  in  the  treatment  of  infec- 
tious diseases  of  the  mouth  and  throat. 

To  obtain  the  best  results  from  peroxide  of  hydrogen,  it 
should  be  kept  in  a  cool  place,  tightly  stoppered,  and  when  re- 
quired for  use  as  much  as  desired  should  be  poured  from  a 
large  bottle  into  a  small  receptacle,  and  only  the  quantity  to 
be  used  at  a  time  be  exposed  to  the  light.     For  injection,  a 


PEROXIDE  OF  HYDROGEN.  467 


small  glass  or  rubber  sj^ringe  should  be  used,  as  contact  with 
metal  destroys  its  utility. 

As  a  test  for  peroxide  of  hydrogen  Dr.  Chas.  Mayr  suggests 
a  paper  saturated  with  a  mixed  solution  of  iodide  of  potassium 
and  dithionate  of  soda.  The  peroxide  of  hydrogen  liberates 
the  iodine  in  the  iodide  of  potash,  but  this  liberated  iodine  is 
immediately  seized  by  the  dithionate  of  soda  and  a  colorless 
solution  is  the  result.  But  if  enough  of  the  peroxide  is  ap- 
plied the  blue  spot  will  appear,  because  more  iodine  is  liberated 
than  can  be  used  in  oxidizing  the  dithionate  of  soda  to  tetra- 
thionate  of  soda  ;  to  make  the  reaction  more  pronounced  still, 
a  little  starch-paste  is  added.  By  this  paper  one  drop  of 
peroxide  of  hydrogen  of  12  volumes  of  oxygen,  produces  a 
blue  spot  in  20  seconds ;  with  six  volumes  in  from  one  to  two 
minutes;  and  with  four  volumes  no  blue  spot  is  produced, 
only  possibly  a  blue  rim. 

Dose. — Of  peroxide  of  hydrogen,  gr.  iij  to  gr.  v,  containing 
six  times  its  volume  of  oxygen,  or  two  per  cent.  In  opera- 
tions on  mucous  membrane,  a  strong  solution  of  peroxide  of 
hydrogen — twelve  per  cent. — greatly  facilitates  by  decolorizing 
the  blood  and  by  its  cleansing,  styptic  action. 

DeJital  Uses. — Peroxide  of  hydrogen  is  a  valuable  remedy 
in  dental  therapeutics,  especially  in  the  treatment  of  alveolar 
abscess,  alveolar  pyorrhoea,  ulcerations  of  oral  mucous  mem- 
brane, gangrene  or  cancrum  oris,  fungous  growths,  bleaching 
discolored  teeth,  putrescent  pulps,  etc.,  etc. 

A  twenty  per  cent,  solution  has  been  recommended  for  the 
arrest  of  hemorrhage,  after  tooth  extraction,  by  Mr.  Bennett. 

Dr.  A.  H.  Prince's  method  of  treatment,  in  the  case  of  alve- 
olar abscess,  illustrates  the  properties  of  peroxide  of  hydrogen. 
"  The  septic  abscess  is  caused  to  heal  by  one  application  made 
in  the  following  manner  :  After  removing  the  pulp  and  pass- 
ing a  broach  through  a  canal  of  the  root  into  the  abscess 
cavity  a  drop  of  the  liquid  is  injected  by  means  of  Farrar's 
syringe.  The  cavity  of  the  crown  is  then  immediately  closed 
with  softened  gutta  purcha,  before  which,  under  pressure  of 
the  finger,  the  liquid  is  driven  into  the  abscess  cavity.     Upon 


468  DENTAL   MEDICINE. 

coming  into  contact  with  the  pus  in  the  fetid  cavity,  the  Hber- 
ated  gas  permeates  it  throughout,  and  by  the  continued  evolu- 
tion of  the  gas  the  cavity  is  emptied  of  its  contents,  which 
boil  out  at  the  fistulous  opening  so  thoroughly  mixed  that  the 
appearance  is  that  of  foam  or  froth ;  while  the  remnant  thus 
removed  is  rendered  so  thoroughly  antiseptic  that  the  healing 
process  proceeds  uninterruptedly."  Dr.  A.  W.  Harlan  has 
successfully  employed  the  peroxide  of  hydrogen,  in  connec- 
tion with  iodide  of  zinc  solution  and  other  agents,  in  the  treat- 
ment of  alveolar  pyorrhoea. 

Dr.  Harlan's  treatment  is  as  follows:  First  pack  the  pus 
pockets  with  iodoform  and  eucalyptus,  iodoform  and  oil  of 
cinnamon,  or  thoroughly  syringe  with  a  one  to  three  grain 
solution  to  the  ounce  of  water  of  chloride  of  alumina,  a  method 
which  will  relieve  the  suffering  and  reduce  the  swollen  gums 
to  their  normal  size.  In  three  or  four  days  the  sanguinary 
deposits  maybe  removed,  and  the  edges  of  the  alveolar  scraped 
or  burned  off.  The  pockets  are  then  syringed  with  peroxide 
of  hydrogen,  and,  after  drying  the  gums,  injected  with  one> 
two  or  three  drops  of  a  solution  of  iodide  of  zinc,  grs.  xii  to 
the  ounce  of  water.  On  the  fourth  day  the  gums  are  carefully 
dried,  and  a  fine  cone  of  cotton  or  bibulous  paper  moistened 
with  peroxide  of  hydrogen,  gently  pressed  into  each  pocket. 
If  any  effervescence  occurs,  it  denotes  the  presence  of  pus, 
when  each  pocket  should  again  be  injected  with  the  iodide  of 
zinc  solution.  In  chronic  cases,  after  syringing  with  the  per- 
oxide of  hydrogen,  a  stronger  injection  of  the  iodide  of  zinc 
(grs.  xxiv  to  the  ounce  of  water)  is  made,  and  in  very  bad  or 
hopeless  cases  even  a  stronger  solution  of  the  zinc  (grs.  xlviii 
to  the  ounce  of  water) ;  and  when  the  gingival  margins  pre- 
sent a  ragged  border  or  cone-shaped  slit,  pure  granular  iodide 
of  zinc  is  applied  to  such  edges.  The  injection  into  the 
pocket  is  repeated  every  fourth  day.  In  some  cases  constitu- 
tional treatment  is  also  required.  Peroxide  of  hydrogen  has 
also  been  successfully  used  for  bleaching  discolored  teeth,  first 
adjusting  the  rubber  dam  and  repeatedly  washing  out  the 
cavity  with  the  peroxide  of  hydrogen,  and  then  carefully  dry- 


PEROXIDE  OF  SODIUM.  469 


ing  with  the  hot-blast  syringe.  A  small  quantity  of  chloride 
of  alumina  is  then  placed  in  the  cavity  and  moistened  with 
peroxide  of  hydrogen  and  allowed  to  remain  for  five  minutes, 
and  then  washed  out  with  a  clear  solution  of  sodae  biboras. 

To  Render  the  Hands  Aseptic. — Dr.  Noble  says  :  Trim  the 
nails  reasonably  short,  and  clear  the  subungual  spaces  with 
the  knife  blade.  Then  thoroughly  wash  the  hands  and  fore- 
arms in  warm  water,  a  good  lather  being  made  with  soap,  and 
a  stiff  brush  vigorously  applied.  Renew  the  water  three 
times.  Next  soak  the  hands  in  a  saturated  solution  of  oxalic 
acid.  According  to  circumstances  the  finger  tips  are  then 
soaked  in  peroxide  of  hydrogen.  For  the  final  bath,  cor- 
rosive sublimate  solution,  i  to  1 000,  is  employed;  allow  the 
hands  to  remain  in  this  solution  three  minutes. 

DENTAL     FORMULAE. 

Antiseptic  and  Slmiulant  Mouth  Wash.  For  Alveolar  Pyorrhoea. 

For    tise     in    Alveolar    Pyorrhoea,  -ps        k     iij    tt 

•^            '  Dr.  a.  W.   Harlan. 
etc.,  etc. 

R.    Hydrogen  perox.    .    .   ^j 

Dr.  Chas.  B.  Atkinson.  Corrosive  sublimate    .  gj.          M. 

R.    Hydrogen  perox.    .    .   giv  Signa. — Inject  into  pockets  until  they 

Tinct.  calendulae     .    .   ^ij.          M.  are  free  of  all  foreign  matter. 
Signa. — Use  daily. 

PEROXIDE  OF  SODIUM— SODIUM  PEROXIDE. 

Formnla. — NagOg. 

Derivation. — Sodium  Peroxide  is  obtained  by  adding  the 
peroxide  of  hydrogen  to  an  excess  of  caustic  soda  solution  of 
twenty  per  cent.,  and  then  pouring  into  alcohol.  Chemically 
considered,  it  is  the  analogue  of  peroxide  of  hydrogen. 

Properties. — It  is  a  strongly  alkaline  and  caustic  white  solid, 
soluble  in  water,  when  it  produces  an  increase  of  temperature 
and  evolves  a  certain  amount  of  oxygen,  with  scarcely  any 
loss  of  the  latter  if  the  peroxide  of  sodium  is  added  to  the 
water  in  small  quantities  and  gradually  stirred  in ;  when  the 
solution  is  made  hurriedly  by  the  addition  of  large  quantities 
of  the  powder  to  the  water  at  a  time,  the  evolution  of  heat, 
due  to  the  energy  of  the  combination,  causes  rapid  elevation 


470  DENTAL  MEDICINE. 


of  the  temperature  of  the  solution  and  the  decomposition  of 

the  peroxide. 

It  is  necessary  to  protect  this  preparation  of  sodium  from 
moisture,  and  if  exposed  to  the  air  its  weight  increases  twenty 
per  cent,  in  twenty-four  hours.  The  presence  of  water  and 
contact  with  organic  matter  produces  inflammation  in  such 
matter,  hence  it  is  necessary  to  handle  this  drug  with  care. 

Peroxide  of  sodium  very  closely  resembles  peroxide  of 
hydrogen  in  the  readiness  with  which  it  separates  from  the 
extra  atom  of  oxygen  it  contains,  and  its  bleaching  property 
depends  upon  this  extra  atom  of  oxygen,  which,  when  liber- 
ated, seizes  upon  the  hydrogen  of  the  organic  color-compound, 
thus  destroying  its  identity.  While  peroxide  of  hydrogen  con- 
tains but  three  or  four  per  cent,  of  available  bleaching  oxygen, 
peroxide  of  sodium  contains  about  twenty  per  cent.,  and  as  a 
bleaching  agent,  antiseptic,  disinfectant  and  sterilizer,  it  has  an 
additional  advantage  over  peroxide  of  hydrogen,  by  possessing 
a  saponifying  and  solvent  action  upon  the  oils,  fats  and  animal 
tissue  present  in  the  dentinal  structure  of  the  teeth. 

On  account  of  its  being  freely  soluble  in  water,  and  uniting 
with  it  so  energetically  as  to  evolve  considerable  heat,  such 
action  can  be  controlled  by  adding  the  powdered  peroxide  of 
sodium  slowly  and  in  small  quantities  to  the  water,  which 
should  always  be  done  in  making  solutions,  as  decomposi- 
tion and  loss  of  oxygen  result  when  such  care  is  not  taken, 
and  the  solution  is  allowed  to  become  hot.  A  standard 
solution  can  be  reduced  to  any  desired  strength  by  adding 
definite  proportions  of  water.  Strong  solutions  of  peroxide  of 
sodium  are  powerfully  caustic  and  dissolve  animal  tissue  and 
saponify  oils  and  fats. 

Dental  Uses. — Peroxide  of  sodium,  when  carefully  employed, 
has  proven  highly  successful  as  a  bleaching  and  sterilizing 
agent.  A  solution  varying  in  strength  from  full  saturation 
to  one  containing  about  five  per  cent,  of  the  saturated  solution, 
has  been  employed  by  Dr.  E.  C.  Kirk  in  the  treatment  of 
pulpless  teeth  with  putrescent  canal-contents,  and  especially  in 
such  cases  where  the  whole  structure  of  the  dentine  was  per- 


PEROXIDE  OF  SODIUM.  471 


meated  and  colored  by  an  offensive  and  fermenting  mass  of 
decomposing  organic  matter,  with  often  a  blind  abscess  as  an 
accompaniment  to  add  to  the  foulness  present,  with  satisfac- 
tory results.  He  recommends  flooding  the  pulp-chamber  and 
canals  with  a  fifty  per  cent.,  or  even  a  saturated  solution,  of 
peroxide  of  sodium,  with  the  rubber-dam  in  position  to  pre- 
vent contact  of  the  solution  with  the  soft  tissues  of  the  mouth, 
the  activity  of  the  preparation  being  at  once  shown  by  the 
evolution  of  gas  similar  to  the  action  of  peroxide  of  hydrogen, 
but  with  less  violence  and  rapidity.  Peroxide  of  sodium  is 
also  very  effective  as  a  bleaching  agent  for  carious  and  dis- 
colored dentine.  For  bleaching  purposes,  Dr.  Kirk  recom- 
mends saturating  the  dentine  with  a  strong  solution  of  per- 
oxide of  sodium  (50  per  cent.),  following  this  by  treatment 
with  a  dilute  acid,  such  as  hydrochloric,  sulphuric  or  acetic, 
or  a  ten  per  cent,  solution  of  trichloracetic  acid  ;  the  pref- 
erence is  given  to  hydrochloric.  In  addition  to  such  prop- 
erties, peroxide  of  sodium  completely  sterilizes  the  dentine 
by  acting  as  a  mechanical  cleanser,  and  a  solvent  of  the 
organic  debris  and  fats,  in  the  form  of  small  shreds  of  pulp- 
tissue  and  organic  matter  in  a  partially  decomposed  state. 
Dr.  Kirk  also  recommends,  after  the  application  of  the  per- 
oxide of  sodium,  inserting  into  the  canals,  for  a  moment  on 
cotton,  a  diluted  solution  of  hydrochloric  or  sulphuric  acid, 
afterwards  washing  and  drying  with  hot  air,  and  then  imme- 
diately filling  them.  For  the  upper  teeth  he  recommends  that 
the  application  of  the  solutions  be  in  pledgets  of  asbestos 
fibre,  as  the  cotton  is  rapidly  disintegrated  by  strong  solutions. 
Dr.  L.  P.  Van  Woert  suggests  the  following  method  of  pre- 
paring the  most  satisfactory  solution  of  peroxide  of  sodium: 
"  Take  a  common  tumbler  about  half  full  of  distilled  water, 
place  it  in  the  centre  of  a  good-sized  pudding-dish,  and  pour 
all  the  cold  water  around  it  possible,  without  floating  the 
glass.  Add  the  sodium  peroxide  in  very  small  portions — 
about  what  could  be  taken  upon  the  point  of  the  large  blade 
of  a  pocket-knife — dusting  in  the  water  slowly  to  cause  as 
little   agitation   as- possible,   and  this   amount  should  not  be 


472  DENTAL  MEDICINE. 


added  oftener  than  once  in  a  half  hour,  being  careful  to  have 
the  sodium  peroxide  finely  powdered.  This  to  be  continued 
until  the  preparation  begins  to  look  opaque  as  powder  is 
added.  Let  it  stand  over-night  and  it  is  then  ready  for  use. 
If  a  lump  about  the  size  of  a  small  bean  is  dropped  into  water, 
you  will  notice  on  the  margin  of  the  line  of  agitation  a  ring  of 
color  resembling  iodine.  If  the  peroxide  is  put  in  the  water, 
as  I  have  suggested,  there  will  be  very  little  surface  agitation 
and  none  of  the  discoloration,  the  result  of  which  is  a  solution 
that  has  never  failed.  This  takes  several  days  to  make,  but  it 
will  more  than  pay  for  the  time  consumed,  in  its  prompt  action 
as  a  bleacher  and  sterilizer.  I  have  placed  this  solution  in  the 
hands  of  a  number  of  gentlemen,  to  be  used  in  the  treatment 
of  abscessed  roots,  and  up  to  the  writing  of  this  not  a  single 
failure  has  been  reported.  The  general  impression  is  that 
sodium  peroxide  is  for  bleaching  only,  while  it  is  the  most 
valuable  preparation  ever  found  for  the  treatment  of  dead 
teeth,  if  used  in  the  following  manner :  Cleanse  the  root-canals 
of  such  septic  matter  as  possible  to  get  at  with  instruments, 
and  dry  them  with  hot  air;  then  carry  small  ropes  of  cotton, 
saturated  with  a  full  strength  solution,  as  near  the  foramen  as 
you  can,  using  orange-wood,  shaped  like  fine  probes,  and  cover 
with  a  temporary  stopping,  letting  the  whole  remain  for  two 
days,  after  which  wash  with  hot  water,  and  fill  in  the  usual 
manner."  When  peroxide  of  sodium  is  introduced  into  a 
pulp-canal  a  chemical  reaction  takes  place,  and  like  peroxide 
of  hydrogen,  it  is  an  active  oxidizer  from  the  facility  with 
which  it  parts  with  one  atom  of  oxygen  ;  it  is  also  a  saponifier 
and  solvent  of  the  pulp-tissue,  and  of  oils  and  fats.  Its  effects 
on  the  fibrils  are  to  dissolve  and  saponify  them  as  a  bleaching 
agent,  for  it  extends  far  into  the  dentinal  tubuli. 

PHENACETINE— PARAACETPHENITIDINE. 

Formula.-— C,,U,,-NO,=C,H—{OC2U,)NH{C,H,0). 

Medical  Properties  and  Therapeutic  Uses. — Phenacetine  is 
slightly  soluble  in  water,  but  freely  soluble  in  alcohol,  and  has 
proven  to  be  a  most  reliable  antineuralgic  without  deleterious 


PHENATE  OF  COCAINE.  473 

effects.  It  causes  no  nausea,  vomiting  or  diarrhoea ;  no  col- 
lapse, no  cyanosis,  or  depressing  after-effects.  It  is  thought 
to  produce  its  effects  by  slowly  dissolving  in  the  lactic  acid  of 
the  stomach. 

Prof.  Rumpf  considers  phenacetine  to  be  not  a  narcotic,  but 
an  antineuralgic  acid  from  its  strong  antipyretic  action. 

The  mode  of  action  is  probably  a  direct  influence  on  the 
central  nervous  system — that  of  the  vaso-motor  more  espe- 
cially, for  phenacetine  acts  especially  on  the  vaso-motor 
neuroses,  which  indicates  a  powerful  effect  on  the  circulation. 
Phenacetine  is  a  strong  analgesic,  and  thought  to  be  more 
powerful  in  its  action  than  either  antipyrine  or  antifebrin,  and 
it  acts  very  rapidly  notwithstanding  its  insolubility  in  the 
gastric  juice.  About  twenty  minutes  after  its  administration 
its  effects  may  be  observed.  It  is  employed  in  the  various 
forms  of  neuralgia,  hemicrania,  acute  rheumatism,  vaso-motor 
neuroses,  neurasthenia,  locomotor  ataxia,  etc.,  etc. 

Dose. — As  an  antineuralgic  the  dose  ranges  from  eight  to 
twenty-two  and  a  half  grains  (one-half  to  one  and  one-half 
grams).  Fifteen  grains  is  the  average  dose.  Good  results  are 
obtained  by  administering  phenacetine  in  gr.  v  doses,  once  in 
an  hour  until  gr.  xv-xx  are  taken. 

Dental  Uses. — Phenacetine  is  employed  in  neuralgias  of 
dental  origin,  acute  periodontitis,  and  pericemental  irritation. 

PHENATE  OF  COCAINE— CARBOLATE  OF  COCAINE. 

Derivation. — Phenate  of  cocaine,  as  prepared  by  Merck,  is, 
as  its  name  implies,  a  combination  of  carbolic  acid  and  cocaine 
containing  seventy-five  per  cent,  of  the  cocaine  alkaloid.  It 
is  a  -slightly  colored  substance,  of  the  consistence  of  thick 
honey,  and  possesses  both  antiseptic  and  anaesthetic  properties. 
Hydrochlorate  of  cocaine  is  open  to  the  serious  objection  that 
when  applied  to  cut  surfaces  it  causes  dangerous  systemic  effects 
endangering  the  life  of  the  patient,  and,  has  in  a  limited  number 
of  cases,  it  is  asserted,  caused  death.  The  phenate  of  cocaine, 
on  the  other  hand,  containing  the  alkaloid,  is  not  so  prone 
to  cause  symptoms   of  cocaine  poisoning  or  any  bad  after- 


474  DENTAL  MEDICINE. 


effect.     It  is  soluble  in  alcohol  of  from  thirty  to  fifty  per  cent, 
such  a  solution  possessing  a  faint  odor  of  carbolic  acid. 

Therapeiitic  Uses. — Dr.  D.  B.  Kyle  regards  phenate  of 
cocaine  to  be  as  good  a  local  anaesthetic  as  the  muriate  of 
cocaine,  and  devoid  of  the  dangerous  systemic  effects  of  the 
latter.  The  phenate  of  cocaine  has  been  employed  success- 
fully in  cases  of  cardiac  disease  and  albuminuria,  conditions 
which  contra-indicate  the  use  of  muriate  of  cocaine.  It  is  also 
claimed  to  be  equal  to  any  carbolized  solution  for  its  anti- 
septic properties.  It  can  be  safely  used  on  cut  surfaces.  An- 
other advantage  claimed  for  the  phenate  over  the  muriate  of 
cocaine  is  that  it  coagulates  the  albumen  in  the  tissue,  pre- 
venting the  absorption  of  the  cocaine,  thereby  prolonging  the 
anaesthetic  effect,  although  the  length  of  time  necessary  to 
produce  anaesthesia  is  somewhat  longer  than  that  required 
for  the  hydrochlorate  of  cocaine.  Phenate  of  cocaine  is 
employed  locally,  internally,  hypodermically,  and  in  powder. 

Dose. — The  dose  of  phenate  of  cocaine  is  from  tz  to  i  of  a 
grain.  Hypodermically  for  operations  involving  the  deeper 
tissue,  the  eight  or  ten  per  cent,  solution  will  usually  produce 
sufficient  anaesthesia,  although  it  may  be  applied  locally  in  a 
fifty  per  cent,  solution,  the  strength  in  which  it  is  sold  in 
alcoholic  solution  for  convenience  of  dilution.  In  solution  of 
the  strength  of  50  per  cent,  it  will  coagulate  albumen,  and 
when  topically  applied  to  a  mucous  surface,  such  a  strength 
may  cause  a  slight  slough,  which  may  be  avoided  by  apply- 
ing glycerine  to  the  dried  surface  before  applying  the  phenate 
of  cocaine.  The  50  per  cent,  solution  may  be  diluted  to  any 
extent  desired  by  adding  to  it  equal  parts  of  alcohol  and 
water.  When  diluted  to  a  25  per  cent,  solution  its  power  to 
coagulate  albumen  is  overcome. 

Dental  Uses. — Phenate  of  cocaine  is  employed  as  a  local 
anaesthetic  for  the  extraction  of  teeth,  and  when  employed  in 
a  50  per  cent,  strength  or  diluted,  it  is  applied  to  the  gum, 
previously  dried,  about  the  tooth,  on  a  pledget  of  cotton, 
which  is  allowed  to  remain  for  from  three  to  five  minutes,  and 
repeated  if  the  anaesthesia  is  not  sufficient.     As  in  the  use  of 


PHOSPHATES  AND  PHOSPHITES.  475 


all  other  local  anaesthetics  applied  to  the  mouth,  the  patient 
should  be  cautioned  not  to  swallow  during  the  operation,  to 
avoid  the  benumbing  effect  on  the  throat.  Phenate  of  cocaine 
is  also  used  locally  for  opening  alveolar  abscesses,  treating 
exposed  pulps,  for  sensitive  dentine,  removing  tumors,  hyper- 
trophy of  tonsils  (carefully  applied),  chronic  and  specific  ulcers, 
earache,  removal  of  polypi,  hypertrophic  growths,  and  other 
obstructions,  etc.  It  is  claimed  for  phenate  of  cocaine  that  it 
not  only  relieves  pain,  but  checks  the  progress  of  the  disease. 

PHOSPHATES  AND  PHOSPHITES. 

The  Phosphates  are  ingredients  of  most  of  the  animal  and 
vegetable  foods,  and  a  sufficient  amount  of  phosphorus  is, 
under  normal  conditions,  appropriated  by  digestive  action  for 
the  supply  of  the  system.  Every  part  of  the  body  contains 
phosphate  of  lime ;  and  rickets,  softening  of  the  bones  and 
defective  teeth  result  when  too  little  is  supplied  during  the 
formative  period.  The  blood,  saliva,  gastric  juice,  urine,  milk 
and  the  entire  intercellular  fluid  contain  phosphate  of  lime  in 
solution.  When  this  agent  is  administered  by  the  stomach, 
diffusion  into  the  blood  results  as  a  consequence  of  its  being 
to  some  extent  soluble  in  lactic  and  hydrochloric  acids;  hence 
it  is  very  essential  to  the  nutrition  of  the  body,  and  small 
doses  are  as  effective  as  large  ones,  as  all  in  excess  of  the 
quantity  soluble  in  the  acids  of  the  stomach  is  not  appropri- 
ated, but  passes  off  or  forms  concretions  in  the  intestines. 
Phosphate  of  sodium  is  also  a  constituent  of  the  blood,  and 
by  removing  morbid  states  of  the  mucous  membrane  it  pro- 
motes digestion  and  improves  nutrition  and  the  tone  of  the 
nervous  system.  Large  doses,  on  the  other  hand,  when  ad- 
ministered in  health,  will  impair  digestion.  Phosphorus  exists 
generally  as  a  phosphate,  and  has  a  strong  affinity  for  oxygen, 
compounds  being  rapidly  formed  in  the  stomach ;  but  some 
of  it  may  enter  the  blood  uncombined.  It  is  a  powerful  irri- 
tant poison,  the  dose  being  no  larger  than  tuo  to  -is  of  a  grain. 
The  preparations  of  the  Phosphates  and  Phosphites  are : 
Synipus  Calcii  Lacto-pliospJiatis. — Syrup  of  the  lacto-phos- 


476  DENTAL  MEDICINE. 


phate  of  lime.  Dose. — f5j  to  f.3J.  (See  Syrup  of  lacto-phos- 
phate  of  lime.) 

Compound  Syrup  of  the  Phosphates. — Each  drachm  contains 
two  and  a  half  grains  of  phosphate  of  iron  and  one  grain 
of  phosphate  of  lime. 

Sodii  Phosphas — Phosphate  of  Sodium. — In  the  form  of  large, 
colorless,  transparent  prisms,  with  a  cooling  saline  taste,  feebly 
alkaline  and  no  odor,  and  a  slightly  alkaline  reaction.  Soluble 
in  six  parts  of  water  at  60°  F.,  and  in  two  parts  of  boiling 
water.     Dose,  f5j  to  fSj. 

Calcii  Phosphas' PrcEcipitatus. — Precipitated  Phosphate  of 
Lime.  In  the  form  of  a  white  powder,  with  no  taste  or  odor 
and  insoluble  in  water  or  alcohol.     Dose. — Gr.  ij  to  gr.  v. 

Syrupus  Hypophosphitum. — Syrup  of  Hypophosphites.  Com- 
posed of  hypophosphites  of  calcium,  sodium  and  potassium. 
Dose. — f5j. 

Sodii  Pyrophosphas. — Pyrophosphate  of  Sodium.  In  the 
form  of  colorless,  translucent  prisms,  with  a  cooling  saline  taste 
and  a  feeble  alkaline  reaction,  but  no  odor,  soluble  in  water, 
but  insoluble  in  alcohol.     Dose. — f5ss  to  f  oss. 

Calcii  Hypophosphis. — (See  Hypophosphite  of  Lime.) 

Sodii  Hypophosphis. — Hypophosphite  of  Sodium.  In  the  form 
of  small,  colorless  or  white  prisms,  or  a  white  granular  powder 
with  a  sweetish  saline  taste,  and  a  neutral  reaction,  and  soluble 
in  water.     Dose. — Gr.  v.  to  gr.  x. 

Therapeutic  Uses. — The  phosphates  are  useful  in  rickets, 
mollities  ossium,  non-union  of  fractures,  soft  teeth  of  children, 
caries  and  necrosis  of  bone,  anaemia  of  nursing  mothers,  chronic 
bronchitis,  leucorrhcea.  The  phosphate  of  soda  in  bilious  sick 
headache,  hepatic  colic,  jaundice,  carbuncles,  boils,  etc.,  etc. 
The  hypophosphites  in  phthisis,  emphysema,  fibroid  lung, 
chronic  tuberculosis,  dilated  bronchi,  skin  diseases,  and  all 
diseases  characterized  by  mal-nutrition.  Phosphoric  and  hypo- 
phosphoric  acids  are  frequently  combined  with  many  vege- 
table and  mineral  tonics.  The  hypophosphites  fulfill  nearly 
all  the  indications  of  phosphorus  itself. 


JABORANDI.  477 


PHENOSALYL. 

Derivation. — Phenosalyl  is  produced  by  melting  together 
carbolic  acid  6  parts,  salicylic  acid  i  part,  lactic  acid  2  parts, 
menthol  iV  of  i  part,  which  form  a  clear,  syrupy  liquid,  which 
crystallizes  at  low  temperatures.  It  is  rendered  non-crystal- 
lizable  by  the  addition  of  a  little  glycerine.  It  is  readily  solu- 
ble in  15  parts  of  water,  and  more  readily  in  alcohol  and  ether. 

Therapeutic  Properties,  etc. — Phenosalyl  is  a  new  antiseptic 
mixture  introduced  by  J.  de  Christmas,  of  Paris.  It  is  employed 
in  one  and  two  per  cent,  solutions  for  wound  treatment,  steril- 
izing instruments,  and  generally  as  an  antiseptic. 

PILOCARPUS— JABORANDI. 

Source. — From  the  leaflets  of  the  Pilocarpus  pennatifoliiis,  a 
Brazilian  plant.  The  alkaloid  on  which  the  properties  of  the 
substance  depends  is  pilocarpine ,  which  combines  with  acids 
to  form  salts.  Another  alkaloid  is  jaborine,  both  having  the 
same  chemical  composition,  CuHjgNgOa,  and  pilocarpine  "by 
heat,  merely  by  concentration  of  an  acid  solution,"  is  con- 
verted into  jaborine ;  washing  with  absolute  alcohol  will  sepa- 
rate them  when  united.  The  principal  preparations  are  :  Hy- 
drochlorate  of  pilocarpine — pilocarpines  hydrochloras — which 
is  in  the  form  of  white  crystals,  deliquescent  with  a  slightly 
bitter  taste,  a  neutral  reaction,  and  no  odor.  It  is  very  solu- 
ble in  alcohol,  but  not  soluble  in  ether  or  chloroform  ;  and 
the  fluid  extract  of  pilocarpus — extractimi  pilocarpi  fluidum. 
Belladonna  and  its  alkaloid  atropine  are  antagonistic  to  pilo- 
carpine. 

Medical  Properties  and  Therapeutic  Uses. — Large  doses  of 
crude  jaborandi  cause  nausea  and  vomiting  on  an  empty 
stomach,  and  the  use  of  the  alkaloid  appears  to  have  the  same 
effect  under  similar  circumstances.  It  increases  the  perspira- 
tion and  saliva,  Ringer  stating  that  the  secretion  of  the  sali- 
vary glands  is  augmented  as  much  as  twenty-seven  fluid 
ounces  as  the  result  of  a  full  dose.  The  nauseating  effects  of 
the  alkaloid  pilocarpus   appear  to  depend   upon  its  action  on 


478  DENTAL   MEDICINE. 


the  muscular  layers  of  the  stomach  and  intestines ;  and  the 
increased  secretion  of  the  mucous  membrane  doubtless  results 
from  the  stimulation  of  the  pancreas  and  the  glands  of  the 
mucous  membrane. 

Children  do  not  appear  to  experience  its  influence  to  the 
same  degree,  in  regard  to  salivation,  perspiration  and  tempera- 
ture, as  do  adults.  As  a  general  rule,  drowsiness  follows  the 
profuse  perspiration,  and  pallor  the  flushings  caused  by  the 
drug ;  and  the  languor  and  debility  it  occasions  continue  for 
some  hours.  The  pupil  of  the  eye  is  contracted;  but  this 
organ  generally  recovers  from  its  diminished  vision  after  the 
space  of  one  hour  and  a  half  Jaborandi  is  employed  in 
dropsies  of  the  heart  and  kidneys,  mumps,  diseases  of 
tile  eye,  to  increase  the  secretion  of  milk,  diabetes  insipi- 
dus, diphtheria,  skin  diseases,  etc.  It  is  also  employed  in 
ptyalism  with  advantage,  in  the  form  of  the  hydrochlorate 
of  pilocarpine,  one-third  of  a  grain  three  or  four  times 
daily. 

Dose. — Of  Infusion,  Infusum  Pilocarpi,  Sss  to  Sij.  Of  Fluid 
Extract — Extractuni  Pilocarpi  Fluidimi,  5ss  to  5ij-  Of  tinc- 
ture— Tinctura  Pilocarpi,  5ss  to  5ij-  Of  Hydrochlorate — Pi- 
locarpincB  Hydrochloras,  gr.  j^  to  gr.  ss. 

PINUS  CANADENSIS— ABIES  CANADENSIS. 

Hemlock,  hemlock  spruce  of  the  United  States  and  Canada. 
The  medicinal  portions  are  the  juice  and  bark.  The  concrete 
juice,  which  is  known  as  Pix  Canadensis — Canada  pitch,  is  a 
yellowish  or  faintly  greenish,  transparent,  viscid  liquid,  when 
fresh,  but  afterward  becomes  an  opaque,  reddish-brown,  hard 
and  brittle  mass,  which  contains  resin  and  a  volatile  oil.  It  is 
used  to  make  rubefacient  plasters.  The  bark  is  rough  and 
deeply  furrowed,  and  is  very  astringent,  possessing  properties 
similar  to  those  of  the  white-oak  bark.  An  extract  prepared 
from  the  bark  is  used  as  a  topical  astringent,  but  it  is  not  con- 
sidered to  have  any  advantages  over  other  common  vegetable 
astringents  : 


JAMAICA  DOGWOOD.  479 


For  Inflamed  Mucous  Membrane,  and  for  Use  after  the  Removal 
of  Salivary  Calculus. 

A.  W.  Harlan. 

K  .         Pinus  canadensis  (white) ^ss 

Aqune  ros« 3  iijss 

Eugenol TlXxxx.        M. 

SiGNA. — Use  as  a  lotion  or  on  a  tooth-brush,  3  times  daily. 

PISCIDIA   ERYTHRINA— JAMAICA    DOGWOOD. 

Source. — Jamaica  Dogwood  is  a  plant  indigenous  to  the 
West  Indies,  where  it  has  been  used  as  an  intoxicant  in  taking 
fish.  The  bark  is  the  officinal  portion,  and  is  smooth  and 
bright-colored. 

Medical  Properties  and  Action. — Jamaica  dogwood  is  a  pow- 
erful narcotic,  and,  in  a  measure,  tonic  and  diuretic.  Its  nar- 
cotic properties  are  supposed  to  be  superior  to  opium,  as  it 
does  not  cause  the  disagreeable  after-effects  common  to  that 
drug.  When  chewed,  Jamaica  dogwood  has  an  unpleasant, 
acrimonious  taste.  It  yields  its  virtues  to  alcohol,  but  not  to 
water.  Its  internal  use  is  generally  followed  by  a  sensation 
of  heat,  gradually  extending  to  the  surface,  and  succeeded  by 
profuse  perspiration,  with  profound  sleep.  In  large  doses  it 
produces  general  paralysis,  and  death  from  asphyxia.  It  has 
been  used  as  a  substitute  for  morphine,  which  it  resembles  in 
many  respects. 

Therapeutic  Uses. — The  principal  use  of  Jamaica  dogwood 
is  in  neuralgia,  in  the  form  of  a  tincture  composed  of  Jamaica 
dogwood  5j,  rectified  spirits  f^iv.  It  is  effectual  in  acute  pains 
usually,  and  is  said  to  be  efficacious  in  lunacy,  and  cough  of 
phthisis. 

Dose. — Of  the  tincture  of  Jamaica  dogwood,  f5j. 

Dental  Uses. — Jamaica  dogwood,  in  the  form  of  the  tincture, 
is  efficacious  in  trigeminal  neuralgia,  and  in  odontalgia  result- 
ing from  an  irritable  pulp,  for  which  purposes  a  fluid  drachm 
in  cold  water  may  be  taken  internally,  and  externally  in  the 
case  of  odontalgia,  introduced  on  a  dossil  of  cotton  into  the 
carious  looth. 


480  DENTAL   MEDICINE. 


PLUMBI  ACETAS— ACETATE  OF  LEAD. 
SUGAR  OF  LEAD. 

Form7da.—?h[C,yif:f^^-\-  3  Hp. 

Derivation. — Acetate  of  Lead  is  obtained  by  immersing  lead 
in  distilled  vinegar,  or  litharge  in  pyroligneous  or  crude  acetic 
acid ;  when  the  acid  has  become  saturated,  the  solution  is  per- 
mitted to  cool  and  crystallize. 

Acetate  of  lead  is  a  white  salt,  in  the  form  of  beautiful 
brilliant,  needle-shaped  crystals,  like  long  prisms,  which  efflo- 
resce on  exposure  to  the  air.  It  has  a  sweet,  astringent 
taste,  and  an  odor  of  acetic  acid,  and  is  soluble  in  water  and 
alcohol. 

Medical  Properties  and  Action. — Acetate  of  lead  is  sedative 
and  astringent,  checking  the  secretions  and  reducing  the  activ- 
ity of  the  capillary  system,  and  diminishing  the  force  and  fre- 
quency of  the  pulse.  Like  all  the  salts  of  lead,  it  is  an  irritant 
and  corrosive  poison,  causing  gastro-enteric  inflammation.  It 
requires,  however,  a  large  quantity  (not  less  than  half  an 
ounce)  of  the  acetate  of  lead  to  destroy  life,  as  much  of  it  is 
rejected  by  vomiting.  The  symptoms  of  lead  poisoning,  when 
the  lead  is  slowly  introduced  into  the  system,  are  loss  of  ap- 
petite and  strength,  wasting  of  flesh,  paleness  of  the  face,  con- 
stipation, pain  in  the  joints,  dry  colic,  which  is  relieved  by 
pressure,  neuralgia  of  the  abdominal  muscles,  contraction  of 
the  intestines,  belly  drawn  toward  the  spinal  column,  contrac- 
tion of  the  liver,  jaundiced  skin,  yellow  conjunctiva,  urine 
colored  with  biliary  coloring  matter,  a  blue  line  along  the 
margin  of  the  gum,  about  the  incisor  teeth  ;  also  at  times  a 
bluish  discoloration  of  the  mucous  membrane  of  the  lips 
and  mouth,  dimness  of  vision,  paralysis  of  the  extensor 
muscles  of  the  fingers  and  arms,  death  resulting  from  the 
gradual  failure  of  nutrition  and  the  paralysis  of  the  muscles 
of  respiration. 

When  the  poisonous  dose  is  large,  there  is  intense  gastric 
irritation,  numbness,  paralysis,  coma  and  collapse.  Iodide  of 
potassium  in  large  doses,  also  Epsom  salts  and  sulphur  baths, 


ACETATE  OF  LEAD.  481 


are  the  antidotes  in  chronic  cases  of  lead  poisoning,  and  for 
the  lead  colic,  alum  in  doses  of  one  or  two  drachms  every 
);hree  or  four  hours,  dissolved  in  some  demulcent  liquid,  is 
considered  to  be  the  best  remedy.  For  the  treatment  of  lead 
paralysis,  strychnia  and  electricity  are  employed.  The  blue 
or  slate-colored  line  on  the  gums  is  supposed  to  be  due  to  a 
deposition  of  the  sulphide  of  lead. 

Therapeiitic  Uses. — Acetate  of  lead  is  internally  adminis- 
tered in  dysentery,  diarrhoea,  cholera,  cholera  morbus,  phthisis, 
chronic  bronchitis,  pneumonia,  diseases  of  the  heart,  hemor- 
rhage from  the  lungs,  stomach,  kidneys,  nose,  etc.  ;  diseases  of 
the  eye,  erysipelas,  skin  diseases,  chronic  gastric  catarrh,  gas- 
tralgia,  pyrosis,  summer  diarrhoea  of  children,  humid  asthma, 
whooping  cough,  etc.  ;  but  the  danger  of  producing  toxic 
effects  must  be  remembered  in  its  internal  use. 

Externally,  solutions  of  lead  are  employed  to  relieve  super- 
ficial inflammations,  arrest  morbid  discharges,  and  allay  the 
pain  of  acute  inflammations.  Lead  should  not  be  given  with 
natural  waters  containing  lime,  carbonic  acid,  mineral  acids 
and  salts,  vegetable  acids,  or  vegetable  astringents,  iodide  of 
potassium  and  preparations,  of  opium. 

Dose. — Of  plumbi  acetas,  gr.  ss  or  j  to  gr.  v,  two  or  three 
times  a  day. 

Liquor  Plumbi  Subacetatis  Dilutus — Diluted  Sobition  of 
Subacetate  of  Lead. — Lead  watej-  is  composed  of  subacetate  of 
lead  solution,  f  5ij  ;  distilled  water,  Oj  ;  and  is  a  mild  astrin- 
gent and  sedative  when  applied  externally ;  it  is  never  pre- 
scribed internally.  It  arrests  discharges  from  suppurating  and 
ulcerated  mucous  surfaces,  and  promotes  the  resolution  of 
acute  superficial  inflammations. 

Dental  Uses. — Lead  water  is  employed  in  dental  practice,  to 
relieve  inflamed  gums  and  mucous  membrane  of  the  mouth  ; 
as  an  application  to  indolent  and  foul  ulcers  ;  also  in  the  treat- 
ment of  teeth  after  the  devitalization  and  removal  of  the  pulps, 
to  prevent  peridental  trouble. 

It  proves  serviceable  when  applied  to  chapped  hands  and 
lips.     A  good  ointment  for  such  a  purpose  is  composed  of  a 
31 


482  DENTAL   MEDICINE. 


combination  of  lead  water,  camphor,  white  wax  and   oil  of 
almonds. 

DENTAL    FORMULA. 
For  Acute  Inflammation  of  the  Mucous  For  Chapped  Hands  and  Lips. 

Membrane   of   the   Mouth    and  the      d      ljq     plumbi    subace- 
Giims.  tatis   dilutus     .    .    .    gvj 

R .    Plumbi  acetatis   . '  .    .   gj  Camphoras gr.xl 

Tinct.  opii g  ss  Cerse  albae |  viij 

j\qugg 5x.         M.  Olei  amygdalae  dulcis.   Oj.  M. 

SiGNA. — Apply  as  a  lotion,  on  lint.  Fi^t  cerat. 

SiGNA. — Apply  as  an  ointment. 

For  Periodontitis.  r.       r  ^        j  r^  j    AXt      n^    ti 

/•or  inflamed  Gums  and  After  loath 

McQuiLLEN.  Extraction. 

R .     Liq.    plumbi   subace-  R .    Plumbi  acetatis  .    .    .  gr.xv 

tatis ^ij  Tinct.  opii fjij 

Tinct.  opii gij.         M.  Aquse f^iij-      M. 

SiGNA. — ^Apply  to  cavity  on  cotton  and  SiGNA. — Use    as  a  lotion   and  mouth- 
to  gum  externally.  wash. 

PODOPHYLLUM— MAY   APPLE. 

Source. — The  rhizomaand  rootlets  oi  Podophyllum  peltatum, 
or  May  Apple.  It  contains  the. alkaloid  ^^^r^m;?^',  which  is 
also  peculiar  to  other  plants,  and  two  resinous  substances 
soluble,  one  in  alcohol  and  ether,  and  the  other  in  alcohol  only, 
and  on  which  its  medical  properties  depend.  Both  are  purga- 
tives.    It  has  a  bitter  taste,  with  a  sense  of  acidity. 

Medical  Pj^operties  and  Therapeutic  Uses. — Podophyllum  is 
a  useful  cathartic  and  cholagogue.  In  cases  of  constipation, 
due  to  deficient  secretions  of  the  intestinal  canal  and  liver,  it 
is  a  useful  cathartic,  and  for  habitual  constipation  small  doses 
combined  with  belladonna  are  very  effective.  It  is  also  em- 
ployed in  catarrhal  and  malarial  jaundice,  ascites,  hemorrhoids, 
bleeding  from  stasis  of  the  portal  circulation,  and  torpidity  of 
liver,  as  a  substitute  for  calomel  and  blue  mass.  It  is  slow  in 
its  action,  and  is  therefore  often  combined  with  other  cathartics. 
Podophyllin  is  the  resina  podophylli. 

Dose. — Of  Resina  Podophylli — Resin  of  podophyllum,  gr.  \ 
to  gr.  j.  Of  Extractuin  Podophylli  Fluidum — Fluid  extract  of 
podophyllum,  Hlj  to  5ss.  Of  Abstrachim  Podophylli — Abstract 
of  podophyllum,  gr.  \  to  gr.  j. 


CAUSTIC  POTASH.  483 

POTASSA  CAUSTICA— CAUSTIC  POTASH. 
HYDRATE  OF  POTASH— FUSED  POTASH— OXIDE  OF  POTASSIUM. 

Fornmla. — KO  H . 

Derivation. — Caustic  Potash  is  prepared  by  boiling  a  solution 
of  potash  until  ebullition  ceases,  and  the  potassa  melts  or  as- 
sumes a  solidified  consistence,  when  it  is  poured  into  suitable 
moulds  and  kept  in  well-stoppered  bottles,  as  it  rapidly  deli- 
quesces when  exposed  to  the  air.  It  dissolves  in  water  and 
alcohol,  and  attracts  moisture.  Its  officinal  form  is  that  of 
sticks  of  a  white  and  somewhat  transparent  color,  but  upon 
exposure  to  the  air,  or  if  it  is  impure,  it  becomes  a  dingy  gray, 
o-reenish  or  bluish  color,  and  has  the  odor  of  slaking  lime. 
When  it  is  digested  in  alcohol,  so  as  to  free  it  from  such  im- 
purities as  are  insoluble  in  alcohol,  it  is  called  alcoholic  potassa. 

Medical  Properties  and  Action. — Caustic  potash  is  the  most 
powerful  caustic  and  escharotic  in  use,  and,  when  taken  inter- 
nally, is  a  corrosive  poison.  It  is  only  employed  externally. 
When  applied  to  a  part,  it  rapidly  destroys  its  vitality  to  a 
considerable  depth,  differing  in  this  respect  from  nitrate  of 
silver  (lunar  caustic),  as  the  latter  is  more  limited  in  its  action, 
and  does  not  liquefy  when  it  comes  in  contact  with  the  tissues. 
From  the  penetrating  action  of  caustic  potash,  it  is  necessary 
to  use  it  with  great  care.  It  is  very  deliquescent,  which  is  a 
great  objection  to  its  use  in  some  cases,  but  when  mixed  with 
an  equal  quantity  of  lime,  the  deliquescent  action  is  in  a 
measure  prevented  ;  it  is  then  known  as  potassa  cum  calcc — 
potassa  with  lime,  and  is  in  the  form  of  a  grayish-white  powder, 
which  is  sometimes  made  into  a  paste,  under  the  name  of 
Vienna  Paste,  which  is  milder  and  less  deliquescent. 

Therapeutic  Uses. — Caustic  potassa  is  chiefly  employed  to 
open  abscesses,  and  in  the  treatment  of  chancres,  hospital  gan- 
grene, eczema,  malignant  growths,  to  arrest  the  sloughing  of 
carbuncles ;  in  tetanus,  applied  to  the  spine ;  bites  of  rabid 
animals  and  venomous  reptiles ;  phlegmons  and  incipient  car- 
buncles, to  arrest  Jiheir  progress  ;  to  form  issues,  etc.  To 
prevent  its  coming  in  contact  with  neighboring  parts,  a  piece 


484  DENTAL   MEDICINE. 


of  adhesive  plaster  is  used,  with  an  opening  corresponding  in 
size  to  the  surface  on  which  the  caustic  is  to  act.  When 
mixed  with  water,  in  the  proportion  of  caustic  potash,  5iss  to 
water  foij,  it  forms  a  rubefacient  solution. 

Dental  Uses. — In  dental  practice,  caustic  potassa  is  employd 
in  gangrene  of  the  mouth  (cancrum  oris),  malignant  growths, 
fungous  growths  of  gum,  ulcers,  etc.;  for  opening  abscesses, 
when  it  is  not  prudent  to  use  the  lancet. 

POTASSIUM  BICARBONAS— BICARBONATE  OF  POTASSIUM. 

Formula. — KHCO3. 

Derivation. — Bicarbonate  of  potassium  is  obtained  by  pass- 
ing carbonic  acid  through  an  aqueous  solution  of  carbonate  of 
potassium,  until  it  is  completely  saturated.  The  solution  is 
then  filtered  and  evaporated,  the  product  being  bicarbonate  of 
potassium,  in  the  form  of  transparent,  colorless  crystals,  of  the 
shape  of  irregular  eight-sided  prisms.  It  is  inodorous,  with  a 
saline  and  somewhat  alkaline  taste,  and  is  soluble  in  water, 
but  insoluble  in  alcohol.  Its  incompatibles  are  acids  and 
acidulous  salts,  etc. 

Medical  Properties  and  Action. — Bicarbonate  of  potassium 
is  antacid,  diuretic  and  antilithic.  In  large  quantities  it  is  a 
corrosive  poison. 

Therapeutic  Uses. — It  is  employed  internally  in  acute  rheu- 
matism, gout,  and  uric  acid  lithiasis,  diseases  of  the  skin, 
calculous  affections,  etc.,  etc. 

Dose. — Of  bicarbonate  of  potassium,  gr.  v  to  3j. 

Dental  Uses. — 'Bicarbonate  of  potassium  is  employed  in 
dental  practice  as  an  antacid,  a  solution  being  serviceable  as  a 
mouth-wash, to  prevent  injury  to  the  teeth  from  acid  medicines. 

DENTAL    FORMULA. 
J^or  Neuralgia.  For  Facial  Neuralgia. 


Wales. 


J.  E.  Garretson. 
B; .    Ferri  sulphatis  exsic. 

Potassii  carbonatis.  aa  gr.ccl  R.    Potassii  bicarb.  .    .    .     gss 

Syrup  acacise  .    .        .  q.  s.  M.               Ext.  ergotse  fluidi  .    .  i'T^] 

.Ft.  pil.     No.  100.  Infusi  ergotae  .    .    .    .  fgvj.      M. 

SiGNA. — Begin  with  3  a    day  and  in-       SiGNA. — Tw»   tablespoonfuls    every  4 

crease  to  6 ;  take  several  hundred.  hours. 


BROMIDE   OF   POTASSIUM.  485 

POTASSIUM  AND   SODIUM— KALIUM-NATRIUM. 

A  compound  or  alloy  of  potassium  and  sodium — kaliurn- 
natriiLin,  in  the  form  of  a  soft,  almost  semi-fluid  mass  prepared 
by  Dr.  Emil  Schreier,  and  employed  for  the  treatment  of 
putrescent  pulp-canals.  Dr.  Schreier  claims  that  when  these 
two  alkali  metals  are  inserted  into  the  pulp-canal  they  come 
in  contact  with  a  watery  liquid,  when  immediately  violent 
reaction  takes  place,  the  water  is  decomposed,  with  the 
development  of  considerable  heat,  by  the  production  of  po- 
tassium and  sodium  hydroxide  and  hydrogen.  The  sodium 
and  potassium  hydroxides  unite  with  the  fatty  substances  to 
form  soap,  which  accounts  for  the  characteristic  odor.  The 
compound,  which  is  contained  in  a  tube,  is  applied  to  the  root- 
canal  as  follows  :  When  the  cork  stopper  is  removed  a  paraffin 
layer  covering  the  preparation  is  exposed.  A  barbed  nerve- 
extractor  is  then  pushed  through  this  paraffin  layer  into  the 
preparation,  and  upon  gently  withdrawing  the  instrument 
small  particles  of  the  potassium  and  sodium  compound  adhere 
to  the  barbs  of  the  instrument,  in  which  condition  it  is  ready 
for  introduction  into  the  pulp-canal.  Dr.  Schreier  advises 
care  as  to  its  use,  especially  avoiding  an  excess  at  any  one 
application  ;  otherwise  the  action  would  be  too  violent.  The 
rubber-dam  should  be  applied  in  all  cases.  Practical  tests  of 
this  compound  have  given  satisfactory  results. 

POTASSI   BROMIDUM— BROMIDE   OF   POTASSIUM. 

Formula. — KBr. 

Derivation. — Bromide  of  Potassium  is  obtained  by  adding  a 
solution  of  pure  carbonate  of  potassium  to  a  solution  of  bro- 
mide of  iron.  The  iron  being  precipitated,  the  bromide  of 
potassium  is  obtained  from  the  solution  by  evaporation.  It  is 
in  the  form  of  white  crystals,  without  odor,  wholly  soluble  in 
water,  and  but  sparingly  soluble  in  alcohol,  and  having  a  pun- 
gent, saline  taste. 

Medical  Properties  and  Action. — Bromide  of  potassium  is 
stimulant,  sedative,  narcotic  and  antispasmodic,  and,  being  ab- 
sorbed into  the  system,  can   be  detected  in  the  blood,  urine, 


486  DENTAL   MEDICINE. 


faeces  and  mucus.  If  administered  in  considerable  quantity, 
the  action  of  the  heart,  respiration,  and  the  temperature  are 
depressed,  and  although  in  some  cases  a  transient  excitement 
may  be  caused  by  large  doses,  the  effect  of  this  agent  is  to 
induce  a  sound  and  refreshing  sleep,  and  if  its  use  is  long  con- 
tinued, a  constant  drowsiness  is  experienced.  Bromide  of 
potassium  has  also  the  power  of  lessening  the  sensibility  to 
pain,  especially  causing  a  loss  of  sensibility  of  touch  in  the 
case  of  the  mucous  membrane  and  skin,  which  is  due  to  the 
local  action  of  the  salt  as  it  is  eliminated.  The  long-continued 
use  of  this  agent  also  causes  a  loss  of  motion,  and  if  it  is 
injected  into  the  tissues  of  a  limb,  it  will  cause  paralysis  of 
motion  and  sensibility.  It  also  diminishes  the  sexual  feeling, 
and  the  condition  which  a  long  course  of  the  bromides  develop 
is  known  as  bromism,  which  is  characterized  by  weakness  of 
mind,  confusion,  headache,  pallor  and  anaemia,  uncertain  gait, 
etc. 

Therapeutic  Uses. — Bromide  of  potassium  is  employed  as  an 
internal  remedy  in  cerebral  affections,  acute  rheumatism, 
cholera  infantum,  sea-sickness,  vomiting  of  pregnancy ;  affec- 
tions of  the  heart,  as  shown  by  increased  action  ;  neuralgia, 
maniacal  excitement,  tetanus,  strychnia  poisoning,  epilepsy, 
spasmodic  asthma,  spasmodic  cough,  etc.,  etc. 

Dose. — Of  bromide  of  potassium,  gr.  v  to  5j- 

Dental  Uses. — Bromide  of  potassium  is  a  useful  remedy  in 
infantile  convulsions  from  the  irritation  of  dentition,  and  is  also 
efficacious  in  preventing  such  conditions  by  relieving  the 
irritation ;  also  in  neuralgia,  due  to  diseased  teeth,  and  in 
facial  neuralgia  when  congestive  in  character.  When  com- 
bined with  morphine,  bromide  of  potassium  is  useful  for 
neuralgia  of  the  fifth  nerve  in  the  adult. 

As  its  local  effect  is  to  diminish  sensibility,  it  has  been  ap- 
plied to  the  pharynx  and  velum  palati,  in  order  to  prepare 
such  parts  for  the  taking  of  impressions  for  artifical  palates, 
and  to  overcome  extreme  susceptibility  of  the  mucous  mem- 
brane of  the  roof  of  the  mouth  in  first  wearing  artificial  den- 
tures.    For  such  purposes  the  agent  is  administered  in  one- 


CHLORATE   OF   POTASSIUM.  487 


half  drachm  doses  3  times  daily  for  two  or  three  weeks  previ- 
ously;  or  doses  of  grs.  xx  to  xxx  may  be  given,  repeated  two 
or  three  times. 

DENTAL  FORMULA. 

For  Infantile  Diarrhcea  fro!>i  Reflex  Nervous  Impressions. 

Dr.  Jas.  W.  White. 

R  .         Potassi  bromidi gr.xviij  to  gss 

Potassi  nitratis gr.vj 

Sacchari  lactis ^^^ss.  M. 

Ft.  pulv.  vj. 
SiGNA. — One  powder  every  3  or  4  hours  to  a  child  i  year  of  age. 

POTASSII  CH  LOR  AS— CHLORATE  OF  POTASSIUM. 

Formula. — KCIO3. 

Derivation. — Chlorate  of  Potassium  is  obtained  by  passing 
an.  excess  of  chlorine  through  a  solution  of  carbonate  of 
potassa  and  slaked  lime;  the  chlorine  being  converted  into 
chloric  acid  by  the  hydrogen  of  the  lime  and  the  acid  com- 
bining with  the  potassa,  forming  chlorate  of  potassium.  It  is 
in  the  form  of  colorless  or  white  crystals,  of  a  pearly  lustre, 
altogether  soluble  in  distilled  water,  and  in  twelve  parts  of 
cold  and  two  parts  of  boiling  water.  It  is  inodorous,  with  a 
cool,  saline  taste,  and  when  applied  to  animal  fluids  does  not 
decompose  them  nor  undergo  any  change,  although  perfectly 
soluble  in  such  fluids.  It  is  absorbed  by  the  blood,  and  is 
eliminated  by  the  kidneys. 

Medical  Properties  and  Action. — Chlorate  of  Potassium  is 
detergent,  refrigerant,  diuretic  and  stimulant,  and  its  action  as 
a  refrigerant  and  diuretic  is  similar  to  that  of  nitrate  of  potassa. 
It  improves  the  appetite,  and  on  account  of  the  large  quantity 
of  oxygen  it  contains,  has  been  employed  in  contaminated  con- 
ditions of  the  blood  as  an  oxidizing  agent.  Although  it  may 
be  administered  with  impunity  in  very  large  doses,  yet  exces- 
sive quantities  have  given  rise  to  gastro-enteric  inflammation^ 
with  fatal  effects. 

Therapeutic  Uses. — Chlorate  of  Potassium  is  employed  in 
continued  and  typhoid  fevers,  neuralgia,  croup,  diphtheria, 
sore  throat,   chronic  bronchitis,  phthisis,  scrofula,  erysipelas, 


DENTAL  MEDICINE. 


scurvy,  mercurial  salivation,  etc.,  etc.  Externally,  it  is  em- 
ployed in  the  treatment  of  ozaena,  sore  throat  of  scarlatina, 
pharyngitis,  cancerous  sores,  ulcerated  surfaces,  fetid  and  scrof- 
ulous ulcers,  etc.,  etc.  Poisonous  symptoms  have  resulted 
from  the  habitual  use  of  chlorate  of  potassium,  and  several 
cases  of  death  have  been  recorded. 

Dose. — Of  chlorate  of  potassium,  gr.  v  to  3j,  every  three  or 
four  hours ;  for  children,  gr.  iij  in  sweetened  water  every  four 
hours  for  a  child  three  years  of  age;  gr.  v  for  one  of  eight  or 
nine  years,  with  due  attention  to  the  bowels  and  constitution, 
regulating  the  former  and  supporting  the  latter.  In  the  case 
of  teething  children,  gr.  ij  may  be  administered  to  a  child  of 
one  year  of  age. 

Troclies  of  Chlorate  of  Potassium  are  prepared  by  a  combi- 
nation of  chlorate  of  potassium,  5v  ;  sugar,  5xviij  ;  tragacanth, 
5ij  ;  vanilla,  gr.  xxx  ;  mixed  together  with  water  into  a  mass 
and  divided  into  480  troches,  each  of  which  contains  gr.  v  of 
chlorate  of  potassium ;  useful  for  sore  throat,  etc. 

Dental  Uses. — Chlorate  of  potassium  is  a  valuable  agent  in 
dental  practice  as  an  internal  and  external  resolvent  and 
detergent  remedy  jn  the  various  forms  of  stomatitis, — inflam- 
mation of  the  gums,  aphthae  and  other  ulcerative  affections, 
gangrenous  stomatitis,  mercurial  stomatitis,  erysipelatous 
inflammation  of  the  mouth,  scurvy,  ulcers  of  the  gums,  cheeks 
and  tongue,  abraded  surfaces  of  mucous  membrane,  secondary 
syphilitic  ulcerations  of  the  mouth,  indolent  and  scrofulous 
ulcers,  etc.,  for  such  purposes  being  used  alone  in  the  form  of 
mouth-washes  or  gargles,  or  in  combination  with  tannic  acid, 
alum,  borax,  glycerine,  etc.  In  the  treatment  of  mercurial 
stomatitis,  great  benefit  is  derived  from  both  its  internal  and 
external  use.  For  the  inflamed  gums  of  teething  children  it 
is  employed  as  a  lotion,  with  beneficial  effects.  In  the  form 
of  powder  it  is  a  useful  application  to  ulcerated  and  abraded 
surfaces.  A  simple  gargle  or  mouth-wash  may  be  made  by 
dissolving  one  drachm  of  chlorate  of  potassium  in  four  ounces 
of  water,  or  half  an  ounce  may  be  dissolved  in  a  pint  of  water. 


CHLORATE   OF   POTASSIUM. 


489 


DENTAL    FORMUL.-E. 


For  hijiamed  Gums  after  the  Extrac- 
tion of  Teeth. 
5^ .    Potassii  chloratis     .    .   3  ij 
Tincture  krameria?, 
Glycerini    .    .  aa  .    .  f^ss 

Aquae  rosse ^^i'j-     ^^■ 

SiGNA. — To  be  used  as  a  gargle  6  or  8 
times  daily,  to  harden  the  gums. 

For  Ulcers  and  Siipptirating  Wounds. 

R.    Potassii  chl Gratis     .    .   ^j 

Glycerini ^iss        M. 

SiGNA. — To  be  used  as  a  lotion. 

For  Aphthous  and  SecoJidary  Syphil- 
itic Ulceration  of  the  Mouth  and 
Fauces. 

li .    Potassii  chlorat.  .  .    .   5  iv 

Aquse destillatas  .  .    .   ^x.          M. 

SiGNA. — To  be    used  as   an  antiseptic 

mouth   wash. 

For  Ulceration  of  the  Mouth. 
Bartholow. 

li .  Potassii  chloratis  .  .  g;] 
Acidi  carbolici  .  .  .  ^ss 
Aquse  destillatse     .    .   giv.         M. 

SiGNA. — To  be  used  as  a  lotion. 

For  Ulceration  and  hiflamynation  of 
the  Gums  and  Mucous  Membrane. 


Stocken. 

R .    Potassii  chloratis    . 

•   3iJ 

Sodii  biboratis     .    . 

•  3J 

Potassii  nitratis    .    . 

•  v5^^ 

Aquse  destillatje  .    . 

•  l^"i'j 

SiGNA. — To  be  used  as  a 

gargle. 

M. 


For  Inflammation  of  Gums  and  Mu- 
cous Membrane. 

Stocken. 

li .    Potassii  chloratis    .    .   3  ij 


Sodii  biboratis     ...  3;] 
Potassii  nitratis  .    .    .355 
Tinct.  arnicas  .    .    .    .   .3  ij 

Aquse  rosae o^''J-       M. 

SiGNA. — To  be  used  as  a  gargle. 

For   TnflaiJied    Gums,    Mucous    Mem- 
brane,  etc. 

R.    Potassii  chloratis  .    .     3J 
Sodii  biboratis     .    .    .   3  j 
Aquse  destillatse  .    .    .  ^ij.         M. 
SiGNA. — To  be  used  as  a  mouth  wash 
or  gargle. 

For  Inflamed  Gums  and  Mouth. 

R .  Potassii  chloratis  .  .  3  ij 
Pulv.  aluminis  .  .  .  3  ij 
Aquse  destillatse  .    .    .  ^^x.         M. 

SiGNA. — To  be  used  as  a  gargle.     - 

For  Inflamed  Mucous  Membra?ie. 

R.  Potassii  chloratis  .  .  3J 
Aluminse  Sulph.  .  .  .  3  j 
Aquse  destillatse  .    .    .   ^  iv.        M. 

SiGNA. — To  be    applied    as    a   mouth 
wash. 

For  Periodontitis. 


R .  Potassii  chloratis 
Plumbi  acetas  . 
Aquse  font   .    .    . 


•  3J 

■  9J 


;'j- 


M. 


SiGNA. — To  be  used  as  a  mouth  wash. 

For    Ulceration  of  Gums  and  Mucous 
Membrane  of  Mouth. 

R .    Potassii  chloras  .    .    .31] 

Aquae "^v.  M. 

SiGNA. — A  tablespoonful  three  times  a 

day;  also    as    a    gargle    four  or  five 

times  a  day. 


490  DENTAL  MEDICINE. 


POTASSII  NITRAS— NITRATE  OF  POTASSIUM. 
SALTPETRE— NITRE. 

Formula. — KNO3. 

Derivation. — Nitrate  of  Potassium  is  obtained  in  the  native 
state  in  various  portions  of  the  world ;  but  the  variety  em- 
ployed for  medicinal  purposes  is  prepared  by  purifying  the 
native  production  of  India.  It  can  also  be  artificially  made 
by  combining  decayed  organic  animal  and  vegetable  matters, 
or  by  the  double  decomposition  of  nitrate  of  sodium  and 
chloride  of  potassium.  The  crude  nitre  is  refined  by  re-solu- 
tion and  crystallization.  It  is  in  the  form  of  white,  crystal- 
line, six-sided  prisms,  odorless,  with  a  sharp,  saline,  cooling 
and  slightly  bitter  taste,  wholly  soluble  in  water,  but  insolu- 
ble in  alcohol. 

Medical  Propei^ties  and  Action. — Nitrate  of  potassium  is 
refrigerant,  sedative,  antiseptic,  diuretic  and  diaphoretic.  It 
promotes  the  secretions,  lessens  the  heat  of  the  body  and  the 
frequency  of  the  pulse.  For  allaying  febrile  excitement  it  is 
frequently  employed  in  the  form  of  nitrous  powders  (nitre, 
gr,  X ;  tartar  emetic,  gr.  ^  ;  calomel,  gr.  y^  to  Y^). 

In  overdoses,  nitrate  of  potassium  causes  pain  and  heat  in 
the  stomach,  vomiting  and  purging  of  blood,  inflammation  of 
the  bowels,  great  prostration,  convulsions,  and  sometimes 
death. 

The  antidotes  are  emetics,  mucilaginous  and  demulcent 
drinks,  and  stimulants  to  sustain  the  sinking  powers  of  the 
system. 

Therapeutic  Uses. — Nitrate  of  potassium  is  employed  inter- 
nally as  a  refrigerant  in  febrile  affections,  in  inflammatory  dis- 
eases, acute  rheumatism,  scurvy,  purpura,  haemoptysis,  passive 
hemorrhages,  asthma,  etc.  In  fevers  it  is  frequently  combined 
with  other  remedies.     The  vapor  is  used  in  spasmodic  asthma. 

Dose. — Of  nitrate  of  potassium,  gr.  ij  to  gr.  x. 

Dental  Uses. — In  dental  practice,  nitrate  of  potassium  has 
been  recommended  in  the  incipient  stages  of  alveolar  abscess, 
being  introduced  into  the  pulp  canal  and  secured  by  a  tempo- 
rary filling  in  the  crown  cavity  of  the   tooth.     It  is  also  em- 


PERMANGANATE   OF    POTASSIUM.  491 


ployed  in  inflammatory  conditions  of  the  mucous  membrane 
of  the  mouth  and  throat  in  the  form  of  gargles. 

DENTAL   FORMULiE. 

For   Inflammation    of   the  Mouth  a^id      For  Inflamed  Mttcoits   Membrane  and 
Throat.  Gums. 

T.  W.  White.  R-    Potassii  nitratis  .    .    •   3  s? 

Potassii  chloratis     .    .    ^  ij 
K.    Potassii  nitratis   .    .    .   gij  to    ^ij  Sodii  biboratis     .    .    .   3J 

Aquae  destillatae    .    .    ,   Oj.  M.  Aqua^destillatee  .    .    .   gviij.       Mv 

SiGNA.-To  be  used  as  a  gargle.  SiGNA.— To    be    used   as  an    antiseptic 

and  refrigerant  mouth  wash. 

POTASSII  PERMANGANAS— PERMANGANATE  OF  POTASSIUM. 

Formula. — K2Mn208. 

Derivation. — Permanganate  of  potassium  is  obtained  by  the 
mixture  of  equal  parts  of  black  oxide  of  manganese  and 
chlorate  of  potassium,  with  a  slight  excess  of  caustic  potassa, 
dissolving  in  water,  and  evaporating  to  dryness,  when  it  is 
exposed  to  a  nearly  red  heat;  the  chlorate  of  potassium  yields 
oxygen,  which  changes  the  black  oxide  of  manganese  into 
permanganic  acid,  and  this  acid,  combining  with  the  potassa, 
gives  as  a  product  the  permanganate  of  potassium.  It  is  in  the 
form  of  dark  purple,  slender,  prismatic  crystals,  inodorous, 
very  soluble  in  water,  forming  a  solution  of  a  beautiful  lilac 
color,  even  in  very  minute  .proportion,  and  with  a  sweet,  astrin- 
gent taste. 

Medical  Properties  and  Action. — Permanganate  of  potassium, 
when  taken  internally,  is  supposed  to  oxidize  the  blood.  It  is 
a  stimulant,  mild  escharotic,  and  is  a  powerful  disinfectant,  as 
it  has  a  remarkable  power  of  destroying  fetid  odors  from 
organic  sources,  and  proves  useful  in  preventing  the  spread  of 
infectious  disease.  It  yields  up  its  oxygen  readily,  in  the  form 
of  ozone,  and  its  use  depends  upon  this  property.  It  is  in- 
stantly decomposed  on  reaching  the  stomach. 

Therapeutic  Uses. — Permanganate  of  potassium  is  employed 
with  advantage  in  dyspepsia,  flatulence,  excessive  deposition 
of  fat,  uric  acid  diathesis,  acute  rheumatism,  diabetes,  scarla- 
tina, petechial  fever,  spinal   meningitis.     Condy's    P'luid   is  a 


492  DENTAL  MEDICINE. 


favorite  preparation  with  some,  for  both  internal  and  external 
use.  The  most  important  uses  for  permanganate  of  potassium 
are  externally,  as  a  deodorizer  and  disinfectant,  to  correct  the 
fetor  of  cancer,  abscesses,  ulcers,  caries  of  bone,  ozsena,  otor- 
rhcea,  gonorrhoea,  leucorrhoea,  ulcerated  sore  throat,  etc.,  in 
the  form  of  injections,  lotions  and  spray.  It  is  also  used 
externally  in  the  treatment  of  diphtheria,  in  the  proportion  of 
a  drachm  of  Condys  Fluid  to  the  ounce  of  water.  In  solution, 
permanganate  of  potassium  is  applied  in  varying  strength, 
according  to  the  effect  desired.  As  a  local  stimulant,  as  well 
as  deodorizer,  it  is  useful  in  chronic  and  indolent  ulcers,  car- 
buncles, hospital  gangrene,  etc.  The  powder  may  be  sprinkled 
on  gangrenous  surfaces.  In  concentrated  solution  permanga- 
nate of  potassium  acts  as  a  caustic.  A  strong  solution  is 
composed  of  lo  parts  dissolved  in  90  parts  of  water,  and  is 
employed  in  its  full  strength  in  cancerous,  phagedenic  and 
atonic  ulcers.  For  dressing  simple  wounds,  or  as  an  injection 
in  abscesses,  ozaena,  leucorrhoea,  etc.,  half  a  fluid  ounce  of  the 
solution  may  be  added  to  a  pint  of  water ;  in  gangrenous  and 
diphtheritic  wounds  and  scrofulous  ulcers,  a  fluid  ounce  of  the 
solution  to  a  pint  of  water. 

Dose. — Of  permanganate  of  potassium  for  external  use,  gr. 
y^  to  gr.  j,  three  times  a  day.  Condfs  Fbiid  is  composed  of 
32  grains  of  permanganate  of  potassium  in  one  pint  of  dis- 
tilled water ;  half  a  fluid  ounce  contains  one  grain.  Dose  of 
Condys  Fluid,  TTLv.  For  external  application,  foj,  to  water, 
f  5v  to  X.  Solution  of  permanganate  of  potassium — Liquor 
Potassii  Per7na7tganatis,  is  composed  of  64  grains  of  perman- 
ganate of  potassium  to  one  pint  of  distilled  water.  M.  de 
Lacerda  has  recently  discovered  that  permanganate  of  potas- 
sium is  one  of  the  most  energetic  antidotes  to  the  venom  of 
snakes. 

Dental  Uses. — In  dental  practice  the  permanganate  of  po- 
tassium is  employed  in  the  treatment  of  fetid  and  gangrenous 
ulcerations  of  the  mouth,  such  as  cancrum  oris,  foul  abscesses, 
ulcerations  of  mucous  membrane  attended  with  fetid  discharges, 
offensive  breath ;  as  an  antiseptic  for  decomposing  pulps  of 


WILD  CHERRY.  493 


teeth  (grs.  ij  to  water  oj);  in  diseases  of  the  antrum,  such  as 
abscess,  and  caries  and  necrosis  of  the  maxillary  bones,  Riggs' 
disease,  ulcers  of  the  mouth,  pyorrhcea  alveolaris,  etc.  (grs.  x 
to  water  Sj).  The  powdered  crystals  introduced  into  a  carious 
cavity  will  relieve  odontalgia.  The  stains  of  permanganate  of 
potassium  can  be  removed  by  dilute  hydrochloric  acid. 

DENTAL  FORMULA. 

For    Unhealthy   Ulcers  of  the  Mouth.       For  Fetid  Perspiration  and  Foul  Breath 

and  Offensive  Breath.  r>       r>  ^      ■■ 

^  ii .    Fotassii  permanganatis  .    gr.  j 

J.W.White.  Aquse  destillau^e     .    .    .    fgi.    M. 

R  .    Potas.  permanganatis  .  ^j  ^'^  i^  SiGNA. — To  be   used   as  a  lotion    and 

Aquse  destillat^  .    .    .  Oj.  M.  gargle. 

SiGNA. — To  be  used  as  a  gargle. 

For  a  Disinfectant  in  Mercurial  Sali- 

For     Gangrenous     Ulceration    of  the  vation. 

MovJh—Cancrum  Oris.  jj     Potassii  permanganatis  .  gr.  xv 

R.    Potassii  permanganatis  gr.  XXX  Aquae  destillatse     .    ,    .f^viij.  M 

Aquae destillatae  .    .    .  ^j.  M.  SiGNA. — Use  as  a  gargle. 

SiGNA. — Apply  as  a  lotion. 

For  Ulcers,  Abscesses,  Decomposing  Pulps  of  Teeth,  etc. 

R.         Liquoris  potassii  permanganatis .    .    .   ^j 

Aquse  destillatse ^  vj  to  x.    M. 

SiGNA, — To  be  used  as  a  gargle  or  as  an  injection. 

PRUNUS  VIRGINIANA— WILD  CHERRY. 

Source. — Prunus  Virginiana  is  obtained  from  the  bark  of 
the  Prunus  Serotina,  and  is  composed  of  amygdalin  and  emul- 
sion, from  which,  by  their  reaction,  tannic,  gallic  and  hydro- 
cyanic acids  are  produced.  The  preparations  of  wild  cherry 
are:  Infusian  Pruni  VirginiancB — Infusion  of  wild  cherry;  Ex- 
tractiim  Pruni  VirginiancB  Fluiduni — Fluid  extract  of  wild 
cherry  ;  Syrupus  Pruni  VirginiancB — Syrup  of  wild  cherry. 

Medical  Properties  and  Therapeutic  Uses. — Wild  cherry  is  an 
aromatic  bitter  stomachic,  tonic  and  expectorant.  It  is  em- 
ployed as  a  stomachic,  tonic  and  in  catarrhal  conditions  of  the 
bronchial  mucous  membrane,  phthisis,  etc.  The  syrup  forms 
one  of  the  ingredients  of  many  cough  mixtures. 

Dose. — Of  tincture  of  wild  cherry,  oss  to  5  ij  ;  fluid  extract, 
5ss  to  5  ij ;  infusion,  5ss  to  5J. 


494  DENTAL   MEDICINE. 


PYOCTANIN— METHYL-VIOLET— PYOCTANINE. 

Derivation. — Pyoctanine  is  only  a  name  applied  to  the  well 
known  aniline  color  methyl-violet,  an  aniline  dye,  which  is  in 
the  form  of  a  paste  and  in  crystals. 

It  is  without  color, but  slightly  irritant,  and  non-intoxicating. 
It  has  been  employed  in  the  form  of  powder^  solution  and 
pencil.  The  powder  is  made  by  mixing  2  parts  of  pyoctanine 
or  methyl-violet  with  loo  parts  of  talc  or  other  inert  substance. 
The  solution  is  of  any  strength  from  i  part  in  100  to  i  in  2000. 
Pyoctanine  is  also  used  in  the  form  of  ointment  containing 
from  2  to  10  per  cent.  There  is  also  another  aniline  color — 
the  yellow — to  which  the  same  name  has  been  given ;  but  the 
violet  is  the  stronger. 

Medical  Properties  and  Therapeiitic  Uses. — Pyoctanine  is  con- 
sidered by  many  to  be  an  efficient  germicide.  According  to 
Fessler,  the  micro-organisms  of  pus  are  destroyed  by  it  in  fif- 
teen minutes  when  the  solution  is  of  the  strength  of  i  to  1000. 
This  action  is,  however,  denied  by  Troje,  who  considers  pyoc- 
tanine to  be  less  powerful  than  bichloride  of  mercury,  or  even 
carbolic  acid.  It  does  not  coagulate  albumen,  and  when  applied 
to  the  eye  causes  dilatation  of  the  pupil  without  paralysis  of 
accommodation.  Pyoctanine  is  employed  topically  to  disinfect 
suppurating  or  ulcerated  wounds,  to  stimulate  chronic  ulcers. 
As  an  application  to  open  buboes,  boils,  carbuncles,  chan- 
croids, etc. ;  also,  in  the  form  of  weak  solution,  in  gonorrhoea, 
and  chronic  cystitis.  And  as  a  dusting  powder  in  moist 
eczema,  and  also  in  other  affections  of  the  eye,  the  ear,  nose 
and  throat. 

It  has  no  odor,  and  in  this  respect  is  preferable  to  iodo- 
form, but  it  stains  the  skin  ;  the  discoloration  may  be  removed 
by  cologne  water,  alcohol,  dilute  hydrochloric  or  nitric  acids. 

Dental  Uses. — Pyoctanine  is  employed  in  dental  practice  in 
all  cases  where  ordinary  antiseptics  are  indicated,  as  in  gan- 
grenous pulps,  root-canals,  disinfecting  cavities  before  filling, 
alveolar  abscess,  etc. 


PELLITORY.  495 


PYRETHRUM— PELLITORY. 

Source — Pyrethrum  is  a  native  of  the  Mediterranean  coast, 
and  the  root  is  the  medicinal  portion — pyrethri  radix,  in  the 
form  of  cylindrical,  wrinkled  pieces,  of  the  size  of  the  little 
finger,  hard  and  brittle,  which,  when  dried,  have  little  or 
no  odor.  Externally,  it  is  of  an  ash-brown  color,  within 
white,  and  possesses  an  extremely  acrid  taste,  with  a  burning 
and  tingling  sensation  over  the  whole  mouth  and  throat, 
which  continues  for  some  time,  and  excites  a  copious  flow  of 
saliva. 

Medical  Properties  and  Action. — Pyrethrum  root  is  an  irritant 
and  sialagogue,  and  when  it  is  rubbed  on  the  skin  it  causes 
much  irritation,  and  may  even  excite  inflammation. 

Its  activity  depends  upon  an  acrid  oil  and  a  compound  resin 
called  pyrethrin.  It  is  rarely  used  internally,  and  only  as  a 
masticatory. 

Therapeutic  Uses. — Pyrethrum  has  been  employed  as  an 
excitant  in  paralysis  of  the  tongue  and  muscles  of  the  throat, 
relaxed  sore  throat,  spontaneous  salivation,  certain  forms  of 
headache ;  for  such  purposes  being  chewed,  or  employed  in 
the  form  of  a  gargle,  in  tincture  or  decoction. 

Dose. — Of  pyrethrum  as  a  masticatory,  gr.  xv  to  5j-  Tinc- 
tiira  Pyrethri,  Tincture  Pyrethrum,  is  composed  of  pyre- 
thrum oiv,  rectified  spirit  Oj. 

Dental  Uses. — Pyrethrum  has  been  employed  in  dental  prac- 
tice for  neuralgic  affections  of  the  face,  for  which  it  is  chewed  ; 
for  the  relief  of  odontalgia,  in  the  form  of  the  tincture  apphed 
to  the  irritable  pulp  on  a  pellet  of  cotton  ;  as  a  stimulant  to  the 
gums  and  mucous  membrane  of  the  mouth  in  relaxed  condi- 
tions; for  obtunding  sensitive  dentine,  in  the  form  of  a  strong 
alcoholic  extract.  The  ethereal  oil  of  pyrethrum  is  recommended 
as  a  pleasant  and  efficacious  remedy  in  odontalgia,  applied  in 
the  same  manner  as  the  tincture  ;  the  fluid  extract  is  also 
employed  as  an  ingredient  for  local  anaesthetic  preparations, 
combined  with  chloroform,  ether  and  lavender,  etc.,  (See 
Chloroform.) 


496  DENTAL  MEDICINE. 


DENTAL  FORMULA. 
Fo7-  Relaxed  Conditions  of  Mucous  Membrane  of  Month  and  Gums. 

R.        Tinctura  pyrethri f^iij 

Aqu£e i^iij.  M. 

SiGNA. — To  be  used  as  a  stimulant  gargle. 


PYROZONE. 


Formula. — H2O2. 


Derivation. — Pyrozone  has  the  same  formula  as  peroxide  of 
hydrogen,  and  is  presented  in  the  form  of  solution  only. 
Various  percentages  have  been  produced  which  are  devoid  of 
poisonous  properties  and  other  objectionable  features.  It  is 
presented  in  the  following  percentages :  An  aqueous  medicinal 
solution  of  pyrozone,  3  per  cent.;  an  ethereal  solution  which 
is  antiseptic,.  5  per  cent.,  and  a  caustic  ethereal  solution  of  25 
per  cent., — all  of  the  same  formula  H2O2. 

Medical  Properties  and  Action. — The  medicinal  3  per  cent, 
aqueous  solution  acts  with  great  rapidity,  causing  instant 
effervescence,  and  is  a  harmless  antiseptic  externally  or  inter- 
nally. It  is  nearly  neutral,  and  its  cleansing  effects  in  remov- 
ing mucus  are  very  effective.  The  ethereal  5  per  cent,  solu- 
tion is  powerfully  antiseptic,  and  acts  on  pus  with  remarkable 
energy. 

The  caustic  25  per  cent,  solution,  also  ethereal,  is  the  most 
powerful,  and  both  it  and  the  5  per  cent. « solution,  when 
applied  to  the  skin,  cause  a  tingling  sensation  and  a  marble 
whiteness,  similar  in  appearance  to  that  caused  by  carbolic 
acid;  the  discoloration  of  the  pyrozone,  however,  disappears 
after  some  hours  without  leaving  any  marks  or  other  bad  effects. 

The  25  per  cent,  solution  is  not  only  a  powerful  caustic,  but 
is  also  considered  to  be  a  very  safe  one,  as  the  rapid  evapora- 
tion of  its  solvent — ether — leaves  the  concentrated  H2O2 
behind.  When  not  in  use  these  solutions  should  be  kept  from 
contact  with  organic  matters,  on  account  of  their  rapid  action. 
All  of  the  pyrozone  solutions  are  prompt  haemostatics  ;  but 
the  3  per  cent,  solution  is  the  best  for  such  a  purpose,  for  the 
reason  that  its  caustic  action  is  less  than  that  of  the  5  per 
cent,  or  25  per  cent,  solutions. 


PYROZONE.  497 


All  of  the  pyrozone  solutions  are  bleachers,  but  the  5  per 
cent,  and  25  per  cent,  solutions  act  more  promptly  for  such  a 
purpose,  on  account  of  the  action  of  the  hydrogen  on  organic 
coloring  matter,  and  not  by  reaction  due  to  acid.  The  painful 
sensation  produced  by  the  stronger  solutions  coming  in  con- 
tact with  a  healthy  surface  may  be  quickly  relieved  by  rubbing 
freely  with  tannin  and  glycerine ;  and  if  gloves  are  worn  on 
the  hands  placed  in  pockets,  any  stains  on  the  fingers  will  dis- 
appear within  one  hour,  and  no  sloughing  or  soreness  result. 
Care  should  be  exercised  as  to  the  quantity  of  the  pyrozone 
solution  employed ;  hence  cotton,  or  silk  ropes,  or  tampons 
should  not  be  so  saturated  as  to  permit  an  excess  to  be  forced 
out. and  come  in  contact  with  healthy  tissues  or  surfaces  when 
the  pyrozone  is  employed  in  a  pocket  or  fistula.  The  3  per 
cent,  medicinal  solution  is  put  up  in  4  ounce  glass-stoppered 
bottles,  and  the  5  per  cent,  and  25  per  cent,  solutions  in  sealed 
glass  tubes,  the  contents  of  which  can  be  transferred  to  clean 
glass  bottles  with  ground  stoppers,  not  filled  too  full,  and  kept 
in  an  upright  position. 

Therapeutic  Uses. — The  3  per  cent,  solution  of  pyrozone, 
being  free  from  odor  and  toxic  properties,  may  be  used  with 
advantage  when  carbolic  acid  or  other  disinfectant  is  indicated. 
In  certain  forms  of  indigestion  or  dyspepsia,  ulcers  of  the 
stomach,  and  gastritis,  the  3  per  cent,  solution  may  be  given 
internally  in  doses  of  5j  three  times  a  day  before  meals.  In 
long-standing  epilepsy,  Dr.  B.  W.  Richardson  has  administered 
it  in  5ij  doses  twice  daily.  Externally,  the  5  per  cent,  and  25 
per  cent,  solutions  have  been  employed  in  rhinitis,  ulcerations, 
diphtheria,  syphilitic  ulcerations,  old  sinuses,  fistulous  tracts 
from  bone  disease,  lupus  erythematous,  alopecia  areata,  ring- 
worm, nasal  diseases,  etc.,  etc. 

Dental  Uses. — The  3  per  cent,  aqueous  solution  may  be 
used  freely  as  a  mouth-wash,  also  as  a  gargle,  but  considerable 
irritation  follows  its  contact  with  the  throat.  Used  as  a 
mouth-wash  it  will  remove  the  oily  deposit  and  absorbent 
coating  on  the  teeth  of  smokers ;  also  as  an  irrigating  and 
detergent  wash  in  abscesses,  sinuses  and  ulcerations.  The  3 
32 


498  DENTAL  MEDICINE. 


per  cent,  aqueous  solution  is  also  recommended  by  Dr.  C.  B. 
Atkinson  as  a  valuable  adjunct  in  caring  for  a  frequent  condi- 
tion of  children's  mouths,  where,  from  malnutrition  during 
gestation  and  the  sundry  eczemas  of  childhood,  the  teeth 
become  pitted  or  wasted  of  the  enamel,  by  which  cavities  are 
exposed  to  the  destructive  influence  of  caries,  as  the  3  per 
cent,  solution  both  bleaches  teeth  in  this  condition  and 
retards  the  progress  of  destruction. 

The  3  per  cent,  solution  is  also  effective  as  a  wash  or  injec- 
tion into  large  abscess-pockets  as  an  excellent  cleanser  and 
means  of  cure.  As  a  bleaching  agent  the  3  per  cent,  solution, 
however,  is  less  penetrating  in  its  effects  than  either  the  5  per 
cent,  or  25  per  cent,  solutions;  and  used  as  a  spray  it  will  by 
its  oxidizing  effect  bring  to  the  surface  from  between  the 
teeth  any  pus  present.  It  will  also  act  upon  any  incrustations 
about  the  teeth,  softening  them  and  rendering  their  removal 
easy. 

The  5  per  cent,  ethereal  solution  is  employed  in  abscess 
pockets,  fistula  or  sinuses,  fistulous  roots,  alveolar  pyorrhoea, 
small  quantities  only  being  used  at  a  time.  The  solution  may 
be  dropped  from  an  ordinary  glass  stopper,  a  drop  at  a  time 
until  the  desired  effect  is  produced  ;  or  it  may  be  applied  on 
a  tapered  piece  of  orange  wood,  or  on  an  attenuated  glass  rod, 
or  as  an  injection  with  a  syringe,  or  by  a  special  pyrozone 
atomizer  in  the  form  of  spray.  In  treating  fistulae  of  alveolar 
abscesses,  the  solution  may  be  introduced  on  cotton  or  other 
tents,  so  that  it  may  be  carried  well  within  the  tract. 

The  5  per  cent,  solution  is  also  an  efficient  bleacher  of 
discolored  teeth,  and  causes  no  injurious  action  on  the  tooth 
structure,  or  on  myxomatous  tissues ;  and  its  application  to 
ulcerating  surfaces  brings  about  a  rapid  reduction  of  the 
suppuration  without  a  resulting  coagulum. 

The  5  per  cent,  ethereal  solution  of  pyrozone  appears  to  be 
more  generally  serviceable,  but  if  the  ether  is  permitted  to 
evaporate  it  may  become  caustic,  as  concentration  follows 
evaporation.  For  bleaching  discolored  teeth,  a  pledget  of 
cotton  saturated  with  the  solution  may  be  placed  in  the  cavity, 


PYROZONE.  499 

and  the  surface  of  the  crown  of  the  tooth  be  wiped  over  with 
the  same  5  per  cent,  solution  ;  it  is  also  useful  in  removing  the 
green  stain  common  on  the  necks  of  children's  teeth,  but  care 
must  be  taken  that  the  solution  does  not  touch  the  gums. 
Great  care  must  also  be  taken  not  to  allow  the  stronger 
pyrozone  solutions  to  come  in  contact  with  an  exposed  pulp, 
as  it  expands  such  a  tissue  very  greatly,  and  as  a  consequence 
causes  excruciating  pain. 

The  25  per  cent,  solution  of  pyrozone  is  caustic  in  its  action, 
and  its  use  in  preference  to  the  5  per  cent,  solution  will 
depend  upon  the  depth  or  rapidity  of  action  required,  as  the 
5  per  cent,  solution  causes  less  pain,  and  may  answer  better 
when  the  mucous  membrane  is  very  irritable.  To  bleach  a 
discolored  tooth,  or  to  rapidly  cleanse  a  surface,  or  wher^  the 
disease  is  difficult  to  reach  on  account  of  its  depth,  the  25  per 
cent,  solution  answers  better  than  the  5  per  cent,  solution,  on 
account  of  its  prompt  action.  The  antiseptic  and  caustic 
solutions  of  pyrozone  attack  the  hydrogen  in  the  color  com- 
pound in  the  tubuli,  and  when  this  is  given  off  only  water 
remains.  For  bleaching  teeth  the  rubber  dam  is  first  adjusted, 
and  the  apical  foramen  of  the  root  sealed ;  then  by  means  of 
a  glass  atomizer,  the  pyrozone  is  sprayed  into  the  pulp- 
chamber  and  canal,  and  also  into  the  crown  cavity.  The  effect 
is  prompt  and  satisfactory.  The  solution  may  also  be  applied 
on  cotton  or  bibulous  paper,  but  no  metallic  instruments 
should  be  used  in  connection  with  the  agent;  and  to  renew 
the  application  it  is  better  to  drop  the  pyrozone  on  the  cotton 
or  paper,  and  not  dip  again  into  the  bottle. 

Pyrozone  atomizers  are  constructed  with  three  tubes,  one 
each  for  the  upper  and  lower  teeth,  and  one  straight  tube  for 
spraying  other  parts.  For  treating  putrescent  pulps  and 
alveolar  abscesses,  the  dam  is  adjusted,  and  the  solution  of 
pyrozone  carried  into  the  root  and  apical  space  in  the  form  of 
spray,  or  on  cotton  at  the  end  of  a  wooden  probe;  the 
pyrozone  being  applied  until  the  pus  ceases  to  flow,  when  the 
root  canal  is  filled  with  cotton,  which  is  allowed  to  remain 
until  the  following  day,  when  the  filling  may  be  inserted,  or. 


500  DENTAL  MEDICINE. 


if  necessary,  a  second  application  of  pyrozone  made,  which, 
however,  is  seldom,  if  ever,  necessary.  The  contact  of  the 
antiseptic,  and  especially  of  the  caustic  solution  of  pyrozone, 
with  the  gum  or  skin,  causes  a  severe  burning  or  pricking 
sensation,  causing  a  white  stain,  more  of  the  nature  of  a  bleached 
spot  than  a  true  eschar,  which  may  be  prevented  by  previ- 
ously painting  the  exposed  parts  with  glycerin.  The  pain 
may  be  relieved  by  the  application  of  glycerin,  or  glycerite  of 
tannin,  or  a  solution  of  bicarbonate  of  soda  (5ss  to  Sj).  For 
the  deep  pockets  of  alveolar  pyorrhoea,  a  small  tent  of  cotton 
may  be  saturated  with  the  25  per  cent,  solution,  and  its  ap- 
plication will  in  most  cases  terminate  the  suppuration.  (See 
Suppurative  Gingivitis.) 

In  opening  glass  tubes  containing  pyrozone  by  filling  a 
notch  and  then  breaking  off  the  point,  care  must  be  taken  that 
particles  of  the  glass  do  not  enter  the  eye,  by  sudden  explo- 
sion, and  destroy  the  sight. 

QUERCUS  ALBA— WHITE  OAK. 

Source. — White  oak,  the  dried  inner  bark  of  which  is  the 
medicinal  portion,  is  a  common  tree  of  the  natural  order 
AmentacecE.  The  bark  has  a  light-brown  color,  fibrous  texture 
and  an  astringent,  bitter  taste.  Its  medicinal  virtues  depend 
upon  the  presence  of  tannic  and  gallic  acids,  and  a  bitter 
principle  known  as  qiiercin.  Water  and  alcohol  form  with  it 
decoctions  and  tinctures. 

Medical  Properties  and  Action. — White  oak  bark  is  tonic, 
astringent  and  antiperiodic.  It  is  principally  used  as  an  ex- 
ternal application. 

Therapeutic  Uses. — White  oak  bark  is  employed  internally 
in  the  treatment  of  diarrhoea,  dysentery  and  hemorrhoids. 
Externally  in  relaxation  of  the  uvula,  tonsils,  etc. ;  gangrene, 
indolent  ulcers,  leucorrhoea,  atonic  menorrhagia,  fissure  of  the 
anus,  etc.,  etc.,  in  the  form  of  tincture,  decoction,  gargles,  lotions 
and  injections. 

Decoction  of  White  Oak  Bark,  Decoctum  Quercus  AlbcB, 
is  composed  of  oak  bark,  Sj  ;  water,  Oj. 


QUILLAIA   BARK.  501 


Dose. — Of  powdered  white  oak  bark,  gr.  xxx  to  gr.  xl.  Of 
the  decoction  the  dose  is  f  Sss  to  foj- 

Dental  Uses. — In  dental  practice  the  decoction  and  tincture 
are  employed  externally  in  the  various  forms  of  stomatitis, 
sponginess  of  the  gums,  and  relaxed  condition  of  the  mucous 
membrane  of  the  mouth  and  fauces. 

QUILLAYA  SAPONARIA— QUILLAIA  BARK. 
SOUTH  AMERICAN  SOAP  TREE   BARK. 

Source. — Quillaia  Bark  is  obtained  from  an  evergreen  tree 
of  the  natural  order  RosacecB — rose  order,  growing  in  Chili 
and  Peru,  the  inner  bark  being  employed. 

Medical  Properties  and  Action. — Quillaia  bark,  when  bruised 
and  macerated  in  water,  imparts  to  that  liquid  the  property  of 
frothing  like  soap  solution  when  agitated,  which  is  owing  to 
the  saponaria  in  the  bark,  the  same  principle  which  imparts  a 
similar  property  to  soapwort — -saponaria  officinalis.  Quillaia 
contains  no  tannic  acid  or  other  bitter  principle,  and  is  an 
article  of  commerce,  being  imported  in  large  quantities  for 
cleansing  grease  from  cloth,  as  it  does  not  change  the  color  of 
silken  or  woolen  goods ;  it  is  also  used  for  cleansing  the  hair, 
which  it  is  supposed  to  preserve  and  beautify.  When  the 
powder  is  snuffed  up  the  nostrils,  it  causes  sneezing  and  a 
profuse  nasal  discharge. 

Therapeutic  Uses. — Quillaia  bark  has  been  employed  as  a 
febrifuge,  to  arrest  excessive  secretion,  as  an  application  to 
ulcers,  as  a  remedy  for  colds  in  the  head,  when  it  is  used  as  a 
sternutatory,  in  the  form  of  powder. 

The  tincture  is  composed  of  quillaia  bark  i  part ;  alcohol  5 
parts  ;  it  is  also  used  in  the  form  of  infusion  and  fluid  extract. 

Dental  Uses. — Q  uillaia  bark,  in  the  form  of  powder,  tincture 
and  fluid  extract,  is  employed  as  an  ingredient  of  mouth- 
washes, for  its  frothy  and  detergent  properties  ;  it  is  also  used 
as  an  application  to  chronic  ulcers  of  the  mouth,  and  to 
arrest  excessive  secretion  of  the  mucous  membrane  of  the 
mouth. 


502 


DENTAL   MEDICINE. 


DENTAL    FORMULA, 


Deterge7it  Mouth  Wash. 

Am.  Journ.  Pharm. 

R .    Pulv.     potassii     bicar- 

bonatis ^ss 

Mellis giv 

Alcoholis ^ij 

Olei  caryophylli      .    .    q.  s. 
Olei  gaultherise, 
Quillaias       saponarise 

(fluid  ext.)  .  aa  .    .   ^j 
Aqua  destillatce  .    .    .   §ix. 


M. 


To  be  used  after  the  removal  of  sali- 
vary calculus. 


For  a  Mouth  Wash. 

R  .    Pulv.  quillaice  sapona- 

riae ^iv 

Glycerini ^iij 

Alcoholis  dilutus  suffi- 
cient for  2  pints. 
Olei  gaultheriffi  .    .    .  gtt.xx. 
Olei  menthse  .    ,    .    .  gtt.xx.      M. 

Macerate  the  soap  bark  in  the  mix- 
ture of  glycerine  and  alcohol  for  three 
days,  and  filter  through  a  little  mag- 
nesia previously  triturated  with  the  vol- 
atile oils. 


3iv 
§iv 

f^iv 

ibj 
O  iij 
Ov. 


For  Inflamed    Gums    and    Mucous 
Membrane. 
Chapin  a.  Harris. 
R.    Quillaiae  saponarise    .  §viiij 
Pyrethri, 
Radicis  iridis, 
Acidi  benzoici, 
Cinnamomi .  . 
Acidi  tannici  . 
Sodii  boratis  . 
Olei  gaultherjas 
Olei  menthse  . 
Cochineal    .    . 
Sacchari  albi  . 
Alcoholis     .    . 

Aquse  purse    ....  O  v.         M. 
Digest  for  six  days  and  filter. 
SiGNA. — To   be   used   as   a   gargle   or 
mouth  wash. 

Mouth  Wash. 
Dr.  W.  H.  Fowler. 
R .    Fluid  Ext.  Soap  Tree 

Bark ^^K 

Alcohol ^ss 

Glycerine ^jss 

Hamamelis       (Pond's 

Extract) giij 

Oil   of  wintergreen    .  ITtviij 
Oil  of  cloves  ....  TTLv 

Soft  water §v'ij 

Dissolve  the  oils  in  alcohol  and  then 
add  the  other  ingredients. 


QUININE  SULPHAS— SULPHATE  OF  QUININE. 

Formula.— {(Z,^^;^f^^^.-P  SO  ^-^jYiJd. 

Derivation. — The  two  important  alkaloid  principles  of  cin- 
chona are  gtiinia  and  cinchojiia,  which  exist  in  combination 
with  kinic  acid.     (See  Cinchona.) 

Sulphate  of  Quinine  is  obtained  by  boiling  the  powdered 
yellow  cinchona  bark  in  water  acidulated  with  hydrochloric 
acid,  by  which  the  alkaloid  quinine  is  separated  from  kinic 


SULPHATE   OF   QUININE.  503 

and  other  acids,  and  forms  a  soluble  hydrochlorate  or  muri- 
ate, the  salt  being  decomposed  and  the  quinine  precipitated 
by  the  addition  of  lime ;  sulphuric  acid  is  added,  after  diges- 
tion in  boiling  alcohol,  which  dissolves  the  quinine,  and  the 
solution  is  boiled  with  animal  charcoal,  filtered  and  allowed 
to  crystallize.  Sulphate  of  quinine  is  in  the  form  of  colorless, 
very  light  and  silky  crystals,  which  are  readily  soluble  in  alcohol 
and  in  water  acidulated  with  sulphuric  acid,'but  insoluble  in 
ether.     It  has  an  intensely  bitter  taste,  and  is  inodorous. 

Medical  Properties  and  Action. — Sulphate  of  quinine  is  a 
very  valuable  tonic  and  antiperiodic,  also  antiseptic  and  stim- 
ulant. In  small  doses  it  increases  the  fullness  of  the  pulse 
and  action  of  the  heart,  and  improves  the  tonicity  of  the  cap- 
illary vessels,  and  is  diffused  into  various  parts  of  the  sys- 
tem with  great  rapidity.  In  large  doses  it  depresses  the  ac- 
tion of  the  heart,  lowers  the  blood  pressure,  and  enfeebles  as 
well  as  diminishes  the  beats  of  the  pulse.  As  it  accumulates 
in  the  brain,  it  causes  a  fullness  in  the  head,  a  constricted 
feeling  about  the  forehead,  a  buzzing  or  ringing  in  the  ears — 
tinnitiLS  aiirinni,  giddiness,  vertigo  and  deafness,  which  may 
be  permanent  if  the  agent  is  taken  in  excessive  quantity ;  also 
amaurosis  and  amblyopia  may  be  caused  by  full  doses. 
Poisonous  doses  cause  intense  headache,  dilated  pupils,  de- 
lirium, coma  and  convulsions.  Some  five  hours  are  required 
to  bring  about  the  greatest  effect  of  quinine,  although  it  can 
be  detected  in  the  urine  in  about  half  an  hour  after  it  is  taken 
into  the  stomach,  and  elimination,  chiefly  by  the  kidneys,  is 
not  completed  in  a  less  time  than  48  hours,  although  the 
principal  portion  is  excreted  in  12  hours. 

Therapeutic  Uses. — Quinine  is  extensively  employed  in 
periodical  diseases  of  a  malarial  origin,  such  as  intermittent 
fever,  neuralgia  of  various  forms,  as  enteralgia,  hepatalgia, 
nephralgia,  gastralgia,  sciatica,  angina  pectoris,  and  in  cases 
of  debility,  pneumonia,  pleurisy,  endocarditis,  pyaemia,  erysipe- 
las, puerperal  fever,  cerebro-spinal  meningitis,  eruptive  fevers, 
etc.,  etc.,  but  the  most  important  use  of  quinia  is  for  the 
treatment  of  malarial  diseases. 


504  DENTAL  MEDICINE. 


Dose. — Of  sulphate  of  quinine,  gr.  j  to  3j,  in  aromatic 
water,  by  the  aid  of  aromatic  sulphuric  acid,  and  also  as  an 
enema,  or  hypodermically.  Pills  may  be  made  by  combining 
24  grains  of  sulphate  of  quinine  with  14  grains  of  clarified 
honey,  and  dividing  into  24  pills.  Pills  can  also  be  made 
with  glycerine. 

Dental  Uses. — Sulphate  of  quinine  is  internally  employed 
in  dental  practice  in  reducing  inflammation  of  the  peridental 
membrane  when  resorted  to  in  the  early  stages  of  the  disease, 
and  before  effusion  of  inflammatory  products,  cell  proliferation 
and  escape  of  the  white  blood  corpuscles  have  occurred;  also, 
in  hypersensitiveness  of  dentine — three  or  four  grain  doses 
every  four  hours,  until  thirty  grains  have  been  taken  (Klump). 
The  treatment  of  facial  and  other  neuralgic  affections,  espe- 
cially when  of  malarial  origin,  in  cancrum  oris,  for  its  tonic 
and  stimulant  effects,  in  aphthous  ulcerations  of  the  mouth 
and  in  scurvy,  where  the  system  is  much  debilitated,  and 
externally  as  an  ingredient  of  dentifrices,  for  its  tonic  and 
stimulating  properties. 

QUININ.E  HYPOPHOSPHIS— HYPOPHOSPHITE  OF  QUININE. 

Derivation. — Hypophosphite  of  Quinine  is  obtained  by  dis- 
solving quinine  with  hypophosphorous  acid,  or  by  decompos- 
ing sulphate  of  quinine  with  hypophosphite  of  baryta,  filtering 
and  evaporating  the  solution. 

Medical  Properties  and  Action. — Same  as  those  of  sulphate 
of  quinine,  but  not  so  powerful  in  its  action. 

Therapeutic  Uses. — Hypophosphite  of  quinine  is  used  in  all 
cases  where  hypophosphites  are  indicated,  and  its  action  is 
milder,  on  account  of  its  containing  less  acid.  It  is  employed 
as  an  antiperiodic,  and  is  especially  adapted  for  the  treatment 
of  children  during  the  period  of  dentition  when  it  is  accom- 
panied with  emaciation,  loss  of  appetite  and  strength,  and 
when  convulsions  are  threatened. 

Dose. — Of  hypophosphite  of  quinine,  gr.  j  to  gr.  iij. 


RESORCIN.  505 


DENTAL    FORMULA. 
For   Facial  N'euralgia    frotJi    Dental      For  Neuralgia  from   Dental  Disturb- 
Disturbance.  ance. 

BA.RRETT  •  GORGAS. 

R      Ferri  et  quin.  (cit.)  .    .  ^ij  R-  Quininas  sulphatis   .    .  gr.x 

-  Syrap  aurantii    .    .    .  §j  ^^""i  sulphat.  exsic.  .  gr.v 

Aqua  dest §j  ^cidi  arseniosi  .    .    .  gr.ss 

Elixir  calisayse    .    .    .   |ij          M.  Ext.  nucis  vomicae     .gr.v.         M. 

SiGNA.— Coch.  parv.  ter  in  die.  Ft.  pil.  No.  xx. 

SiGNA. — One  pill  every  four  hours. 

For  Neuralgia  Associated  with  ^^^  ^^^^^^  Periodontitis. 

Antzrnia. 

R .   Quininse  sulph    .    .    -  3  ss 

Garretson.  Acidi  sulph.  aromat.  .  gij 

K.   Tinct.  ferri  chloridi     .   5J  Elix.  calisaya  bark  .    .   ,^  xiv.     M. 

Quininas  sulphatis   .    .   3J            M.  SiGNA. — A  tablespoonful  eveiy  two  or 

SiGNA. — Teaspoonful  four  times  daily.  three  hours. 

For  Acute  Alveolar  Abscess  or  Periodic  Supra-orbital  New-algia. 
Cassidy. 

R  .         Quinise  sulphatis gr.xv 

Ft.  capsules  No.  5. 
SiGNA.— Take  one  every  two  hours. 

RESORCIN. 

Derivation. — Resorcin  is  a  chemical  compound  of  the  phenol 
group  and  aromatic  series,  to  which  carbolic  acid  belongs.  It 
is  obtained  from  certain  resins  by  the  action  of  fusing  alkalies, 
and  is  of  the  form  of  tabular,  prismatic,  shining  crystals,  some- 
what sweetish  tb  the  taste,  followed  by  a  slight  pungency. 
Resorcin  is  very  soluble  in  water,  95  parts  in  100,  and  to  a 
less  degree  in  alcohol,  ether,  glycerine  and  vaseline ;  chloro- 
form and  carbon  sulphide  will  not  dissolve  it.  It  darkens  on 
exposure  to  the  air,  and  is  phosphorescent  when  rubbed  in 
the  dark.  Its  odor  is  somewhat  similar  to  that  of  phenol,  but 
not  so  strong. 

Medical  Properties  and  Uses.  —  Resorcin  acts  somewhat 
similar  to  quinine,  although  it  differs  from  the  latter  in  its 
lethal  effects.  ..Quinine,  carbolic  acid,  and  salicylic  acid  pro- 
mote its  effects  ;  atropine  antagonizes  it.  Through  its  action 
on  the  nervous  system  it  greatly  increases  in  frequency  the 
respiration,  which  becomes  convulsive   and   spasmodic,  and 


506  DENTAL   MEDICINE. 


afterward  weak,  but  rapid.  It  also  increases  the  action  of  the 
heart,  causes  the  pulse  to  become  weak  and  irregular.  It  is 
eliminated  by  the  urine  quite  rapidly.  It  has  no  irritating 
action  on  mucous  membranes. 

Therapetitic  Uses. — Resorcin,  on  account  of  its  less  irritating 
property,  is  considered  preferable  to  carbolic  acid  for  internal 
use  and  subcutaneous  injection.  It  is  employed  internally  in 
catarrh  of  the  stomach,  ulceration,  gastralgia,  fermentative  in- 
digestion, fevers,  for  its  antiseptic  and  antipyretic  actions,  and 
ulcerative  endocarditis,  etc.,  etc.  Locally,  on  account  of  its 
antiseptic  properties,  in  diphtheria,  in  syphilitic  and  other 
sloughing  sores,  and  anthrax,  in  the  form  of  crystals  or 
powder,  and  in  the  form  of  spray  in  catarrhal  and  ulcerating 
affections  of  the  nose  and  throat ;  in  solution,  on  account  of 
its  antiseptic  action,  it  is  used  for  dressing  putrid  and  atonic 
wounds,  and  is  combined  with  water,  glycerine  and  alcohol; 
it  is  also  used  in  pomades. 

A  compound  composed  of  resorcin  and  salicylic  acid  heated 
together,  is  known  as  "  Salicyl  Resorcin-Ketone,"  and  is  anti- 
septic to  a  degree,  as  it  limits  the  development  of,  rather  than 
destroys,  septic  germs.  It  is  soluble  in  glycerine  and  alcohol, 
and  is  neither  poisonous  nor  disagreeable  to  the  taste. 

Dose. — Of  resorcin,  gr.  v-xv.  Five  grains  every  two  hours 
in  an  ordinary  case. 

Dental  Uses. — Resorcin  is  a  valuable  antiseptic  in  dental 
practice,  and  may  be  applied  with  advantage  in  all  cases  where 
antiseptics  are  indicated.  A  ten  per  cent,  solution  of  resorcin 
is  recommended  in  cases  of  chronic  alveolar  pyorrhoea  (after 
cleansing  the  pockets  with  peroxide  of  hydrogen)  where  there 
is  impaired  circulation  of  the  tissues.  (See  Antiseptic  Uses  of 
Carbolic  Acid). 

DENTAL   FORMULAE. 

For  Alveolar  Pyorrhoea.  SiGNA. — Use  as  a  mouth-wash  after  re- 

Dr.  a.  W.   Harlan.  moving  all  deposits,  and  the  adjacent 

I,       T,  •  ••  carious  or  necrosed  bone. 

K.    Resorcm ^ij 

..,.,,..  .  A  few  drops  of  oil  of  peppermmt 

Acidi  carbohci   .    .    .  Zj  '^  ,        •,  , 

„,         .    .  „...  or   any  other  desirable    oil    may  be 

Glycerini t  iij  ■' 

.  ^    ...        , ,  added  to  the  above. 

Aquae  q.s o'^i')-       ^- 


RHUBARB.  507 


For  Alveolar  Pyorrhcsa,  For  Mucous  Patches  of  the 

Dr.  a.  W.  Harlan.  Mouth. 

R .    Resorcin gr.xxx 

..,.,..  ^  Dr.  A.  W.  Harlan. 

Acidi  tannici  ....    gr.v 

Olei  cassia TTI  x  o      -o  ■  i 

^  li .    Resorcin gr.  xl 

^^y'^^''™ 3J  Aqu^dest §ss.         M. 

Aquae  dest ^ij.         M. 

SiGNA. — Inject  with  a  syringe  into  the       SiGNA. — Dry   surface    and   paint    with 

remains  of  the  pockets   in  the  after-  above. 

treatment. 

RHEUM— RHUBARB. 

Sotirce. — The  root  ol  Rheiivi  officinale.  It  contains  two  acids, 
rheo-tannic  and  rhewnic,  a  resin,  pliceoretin  and  an  acid,  cliryso- 
phan  or  chrysophani. 

Medical Propei'ties and  Tlierapciitic  Uses. — Rhubarb  possesses 
tonic  and  astringent  as  well  as  purgative  properties.  In  small 
doses,  as  a  tonic,  it  promotes  the  appetite  and  digestive  power, 
and  by  virtue  of  the  tannic  acid  it  contains,  is  astringent.  The 
purgative  principle  it  possesses  enables  sufficient  doses  of 
rhubarb  to  act  as  a  cathartic,  producing  stools  which  are  of  a 
yellowish-brown  color,  and  soft,  but  not  watery.  It  has  no  ten- 
dency to  cause  gastro-enteric  inflammation.  It  is  now  classed 
among  the  cholagogues,  as  it  increases  the  flow  of  bile  and 
the  intestinal  secretions,  which  is  due  to  phaeoretin — rhubarb 
resin.  Its  coloring  matter  not  only  stains  the  stools,  but  also 
the  perspiration,  milk  of  nursing  women,  to  which  it  gives  a 
bitter  taste  and  purgative  principles,  and  the  urine.  It  is  em- 
ployed with  benefit  in  diarrhoea  caused  by  the  accumulation  of 
undigested  food  in  the  intestines,  hemorrhoids  accompanied 
by  constipation,  dyspepsia  with  deficient  biliary  and  intestinal 
secretions,  the  summer  diarrhoea  of  children  in  the  form  of  the 
aromatic  syrup,  and  in  catarrh  of  biliary  ducts  with  jaundice; 
and  the  chewing  of  rhubarb-root  is  beneficial  in  habitual  con- 
stipation; its  frequent  use,  however,  is  objectionable  on  account 
of  the  astringent  after-effect,  which  in  the  rhubarb  pill  is 
remedied  by  the  soap. 

Dose. — Of  Extractiini  Rhci — Extract  of  Rhubarb,  grs.  x  to 
grs.  XV.     Of  Extractiim  RJiei  Fliiiduni — Fluid  extract  of  rhu- 


508  DENTAL  MEDICINE. 


barb,  5ss  to  5i  .  Of  Pilulce  Rhei — Rhubarb  pills,  each  pill  con- 
sists of  grs.  iij  of  rhubarb  and  gr.  j  of  soap.  Of  Pihilce  Rhei 
Coinpositce — Compound  pills  of  rhubarb,  consisting  of  rhubarb, 
aloes  and  myrrh.  Dose,  2  to  four  pills.  Of  Syrupiis  Rhei — 
Syrup  of  rhubarb,  5ss  to  5ij.  Of  Tinctiira  Rhei  AroTnaticus — 
Aromatic  tincture  of  rhubarb,  5ss  to  5ij.  Of  Tinctiira  Rhei 
Diilcis — Sweet  tincture  of  rhubarb,  5ss  to  oij.  Of  Vinum 
Rhei — Wine  of  rhubarb,  5j  to  Sss.  Oi  Piilvis  Rliei  Compositus 
— Compound  powder  of  rhubarb,  a  teaspoonful. 

RHIGOLENE. 

Derivation. — Rhigolene  is  a  product  of  the  distillation  of 
petroleum.  In  its  composition  it  is  a  hydrocarbon,  and  is 
destitute  of  oxygen,  being  extremely  volatile  and  inflammable, 
and  is  the  lightest  of  all  liquids,  with  a  specific  gravity  of 
0.625.  It  is  a  petroleum  naphtha,  and  boils  at  700  F.,  and 
when  perfectly  pure  should  be  almost  odorless ;  but  it  is 
difficult  to  procure  any  specimen  that  does  not  have  the  un- 
pleasant odor  of  petroleum.  It  is  colorless,  and  on  account 
of  its  great  volatility  and  inflammability  requires  to  be  kept 
tightly  stoppered,  in  a  cool  place.  The  storage  of  large 
quantities,  except  in  very  secure  places,  is  attended  with  con- 
siderable risk,  and  oh  this  account  it  is  somewhat  difficult  to 
procure  it  outside  of  the  manufactories.  It  is  dangerous  to 
use  it  at  night,  or  near  a  light. 

Dental  Uses. — Rhigolene  is  employed,  like  absolute  ether, 
to  produce  local  anaesthesia,  by  dispersing  it  in  the  form 
of  spray,  with  the  spray  apparatus,  being  the  most  rapid  in 
its  congealing  effects,  and  also  the  most  easily  controlled 
and  convenient  of  all  of  the  freezing  mixtures.  As  a  local 
anaesthetic  it  is  employed  in  the  operation  of  extracting 
teeth,  by  applying  it,  in  the  form  of  spray,  to  the  parts 
about  the  tooth  to  be  removed  until  a  blanched  surface  of 
gum  is  produced.  The  spray  of  rhigolene  is  also  applied 
to  the  gum  over  the  root  of  a  tooth  affected  with  incipient 
periodontitis. 


SALOL.  509 

SALOL— PHENYLIC  ETHER  OF  SALICYLIC  ACID. 

Fornm/a. —C,,U,,0,=C,H^  (OH)  (CO.OCgHs). 

Derivation.— ^Ssilol  is  obtained  by  the  combination  of  salicylic 
acid  and  phenol,  consisting  of  60  parts  of  weight  of  salicylic 
acid  and  forty  parts  of  phenol.  It  is  a  white,  crystalline  powder, 
insoluble  in  water,  without  odor  and  nearly  tasteless.  In  the 
system  it  becomes  decomposed,  yielding  salicylic  and  carbolic 
acids  in  nascent  forms. 

Medical  Properties  and  Therapeutic  Uses. — Salol  is  antiseptic, 
germicide  and  antipyretic,  and  possesses  less  poisonous  proper- 
ties than  either  salicylic  acid  or  carbolic  acid  alone;  large  doses 
of  salol,  however,  cannot  be  administered  without  danger  of  phe- 
nol poisoning.  It  is  accumulative,  owing  to  its  being  absorbed 
and  eliminated  slowly,  and  hence  cannot  be  given  too  frequently. 

In  acute  and  chronic  renal  diseases,  salol  is  contra-indicated. 
It  is  employed  internally  in  disorders  of  stomach,  acute  gastro- 
enteritis, tonsillitis,  gonorrhoea,  skin  diseases,  gleet,  etc.  Ex- 
ternally used,  salol  is  an  excellent  dressing  for  wounds,  ulcers, 
burns,  erysipelas  and  skin  diseases.  Camphorated  salol  is 
highly  recommended  by  Cuirllier  in  the  treatment  of  otitis. 
It  can  be  mixed  with  iodoform  oriodol,  and  the  action  of  both 
be  had  simultaneously. 

Dose. — Gr.  v  to  5j. 

Dental  Uses. — Mixed  with  iodoform,  aristol,  or  oxide  of  zinc, 
salol  is  successfully  used  for  capping  exposed  pulps.  It  is 
also  employed  as  a  root-filling  material  by  first  drying  out 
the  root-canals  with  absolute  alcohol  and  hot-air,  then  liquefy- 
ing a  little  salol  in  a  test-tube  over  a  spirit  lamp,  and  injecting 
some  of  the  liquid  by  means  of  a  warm  hypodermic  syringe 
to  the  apex  of  each  root.  It  is  then  allowed  to  crystallize, 
when  it  becomes  very  hard. 

For  Erythema, 
Dr.  a.  Eichler. 

R .        Saloli ^  ij 

Zinci  oxidi 

Pulv.  amyli aa  ^iv 

Lanoline gj-  M, 


510  DENTAL   MEDICINE. 


SANDARACA— SANDARACH. 

Source. — Sandarach  is  a  resinous  substance  obtained  from 
an  evergreen  tree — Thuya  Articulata — which  grows  in  the 
northern  part  of  Africa.  The  gum  is  in  the  form  of  small, 
irregular,  round  and  oblong  tears,  of  a  pale  yellow  color,  some- 
times brown,  and  more  or  less  transparent,  dry  and  brittle.  It 
has  a  faint,  agreeable  odor,  which  is  increased  by  warmth,  and 
a  resinous,  somewhat  acrid  taste.  It  melts  with  heat,  diffusing 
a  strong  balsam  odor,  and  is  inflammable.  It,  is  soluble  in 
alcohol  and  ether,  and  slowly  dissolves  in  warm  oil  of  turpen- 
tine. It  consists  of  three  resins,  varying  in  their  relations  to 
alcohol,  ether  and  oil  of  turpentine.  The  sandaracin  which 
remains  after  sandarach  has  been  exposed  to  the  action  of 
ordinary  alcohol  is  a  mixture  of  two  of  these  resins. 

Uses. — Sandarach  was  formerly  employed  as  a  medicinal 
agent,  and  entered  into  the  composition  of  various  ointments 
and  plasters,  but  its  use  is  now  restricted  to  such  purposes  as 
the  composition  of  a  varnish,  ingredient  of  incense,  etc.  After 
the  erasion  of  ink  marks,  its  powder,  if  rubbed  on  such  a  sur- 
face, will  prevent  fresh  ink  marks  from  spreading. 

Dental  Uses.—\n  dental  practice,  sandarach,  dissolved  in 
alcohol,  forms  a  varnish  for  coating  the  surface  of  plaster 
models,  etc. ;  it  is  also  used  for  checking  secretions  from  the 
gums  during  the  operation  of  filling  teeth,  either  applied  as  a 
coating  to  the  surface,  or  on  bibulous  paper  saturated  with  it. 
It  is  also  employed  to  saturate  cotton  to  be  used  as  a  tempo- 
rary filling  in  cavities  of  the  teeth,  for  the  protection  of  medi- 
cinal applications. 

DENTAL  FORMULA. 
Transparent  Sandarach    Varnish. 

R.        Gum  sandarach _  ^v 

Alcohol .    qt.j 

Mix  and  digest  over  a  moderate  heat  until  the  sandarach  is  dissolved. 

SERPENTARIA— VIRGINIA  SNAKEROOT. 
Source. — Serpentaria    is    prepared    from    the    rhizoma   and 
rootlets  of  the  Aristolochia  serpentaria,  and  of  the  Aristolochia 
reticulata,  and  is   composed  of  a  volatile  oil,  resin  and  bitter 


SHELLAC.  511 

principle.  Its  preparations  are :  Infttsiim  Serpentaria — Infu- 
sion of  Serpentaria;  Tinctura  SerpentaricE — Tincture  of  Ser- 
pentaria ;  Extr actum  Serpentarice  Fhddzun — Fluid  extract  of 
serpentaria. 

Medical  Properties  ajid  Therapeutic  Uses. — Serpentaria  is  a 
bitter,  aromatic,  stimulating  tonic,  emploj^ed  in  typhoid  and 
typho-malarial  fevers,  and  as  a  stimulant  expectorant  in  capil- 
lary bronchitis ;  also  combined  with  the  carbonate  of  ammonia 
in  a  low  form  of  pneumonia,  chlorosis,  anaemia  and  diphtheria. 
Large  doses  cause  diarrhoea,  nausea,  vertigo  and  headache. 

Dose. — Of  Infusion,  oSS  to  oj ;  Tincture,  5ss  to  5ij ;  Fluid 
extract,  .5ss  to  5ij. 

SHELL-LAC— SHELLAC. 

Source. — Lac  is  a  resinous  substance,  obtained  from  several 
varieties  of  trees  which  grow  in  the  East  Indies,  and  particu- 
larly from  the  Croton  Lacciferum,  and  two  species  of  the  Ficus. 
It  is  supposed  to  be  an  exudation  from  the  bark,  owing  to  the 
puncture  of  an  insect  belonging  to  the  genus  Coccus ;  it  is  also 
said  to  be  the  exudation  from  the  bodies  of  the  insects  them- 
selves. Several  varieties  are  known  in  commerce,  the  most 
common  being  the  stick-lac,  the  seed-lac  and  the  shell-lac- 
Lac,  in  its  crude  state,  consists  of  resin,  coloring  matter,  and 
a  peculiar  principle,  insoluble  in  water,  alcohol  or  ether,  and 
known  as  laciii,  a  little  wax,  and  various  saline  matters  in  small 
proportion. 

Uses. — It  is  slightly  astringent,  and  has  been  recommended 
as  an  adhesive  substance  for  dressing  ulcers,  wounds,  etc., 
being  used  by  simply  spreading  it  on  the  bandages  after  it  is 
dissolved  in  alcohol  by  a  gentle  heat.  Shellac  is  prepared  by 
melting  the  crude  lac,  straining  it,  and  pouring  it  upon  a  flat, 
smooth  surface  to  harden.  It  is  in  the  form  of  thin  frag- 
ments of  various  sizes,  from  half  a  line  to  a  line  in  thickness, 
and  of  a  light  and  also  a  dark  brown  color,  shining,  hard,  brit- 
tle and  inodorous.  It  is  insoluble  in  water,  but  freely  soluble 
in  alcohol,  especially  with  the  aid  of  heat.  It  is  employed  as 
a  varnish.    In  dental  practice  its  uses  are  the  same  as  those  of 


512  DENTAL  MEDICINE. 


sandarach,  iDut  owing  to  the  dark  brown  color  of  the  solution, 
it  is  not  so  sightly,  and  does  not  make  a  transparent  varnish. 

DENTAL    FORMULA. 
For  a  Colored  Varnish.  For  an  Aqueous  Varnish. 

R.    Gum  shellac  .    .    .    .  gv  R.    Pulv.  shellac  ....  partes j 

Alcohol qt^-  j-  Sat.  solut.  boracis   .    .  partes  ij 

Mix  and  digest  over  a  moderate  heat  Mix  by  shaking  together;  it  will  give 

until  thoroughly  dissolved.  a  starch  gloss. 

Shellac  may  be  dissolved,  without  the  aid  of  alcohol,  by  a 
saturated  solution  of  borax  in  water.  This,  however,  does  not 
give  a  very  strong  solution.  To  prevent  cracking  when  the 
shellac  is  dissolved  in  alcohol,  add  a  little  castor  oil ;  if  in  water, 
add  glycerine.  Clear  shellac  varnish  may  be  prepared  by  first 
making  an  alcoholic  solution  of  shellac  in  the  usual  way,  and 
then  adding  a  little  benzole,  and  the  mixture  well  shaken.  In 
from  24  to  48  hours  the  fluid  will  have  separated  into  two 
distinct  layers,  an  upper  alcoholic  stratum,  perfectly  clear,  and 
of  a  dark-red  color,  while  under  it  is  a  turbid  mixture  con- 
taining the  impurities.  The  clear  solution  is  drawn  off  with  a 
pipe,  or  may  be  decanted. 

SOD^  PHENAS— PHENATE  OF  SODIUM. 
CARBOLATE  OF  SODIUM— PHENOL  SODIQUE. 

Formula. — CgHgNaO, 

Derivation. — Phenate  or  Carbolate  of  Soda  is  obtained  by 
mixing  one  part  of  caustic  soda  with  five  parts  of  carbolic 
acid  and  a  small  quantity  of  water,  and  evaporating  the  solu- 
tion, the  result  being  a  saponaceous  mass  of  acicular  crystals 
of  a  light  pinkish  color,  which  are  converted  by  the  heat  into 
a  fluid  of  an  oily  consistence.  It  is  freely  soluble  in  creosote, 
carbolic  acid  and  water. 

Medical  Properties  and  Action. — Phenate  of  soda  is  haemo- 
static, antiseptic  and  disinfectant. 

Therapeutic  Uses. — It  is  internally  administered  in  the  form 
known  by  the  French  name  of  Phenol  Sodique,  in  doses  of  gtt. 
viij  or  gtt.  X  in  a  glass  of  water,  in  typhus  and  typhoid  fevers, 
as  a  preventive  of  cholera,  in  plagues,  cholera  infantum,  etc. ; 


BICARBONATE   OF   SODIUM.  513 


externally,  it  is  a  valuable  styptic  in  local  hemorrhage,  and 
as  a  dressing  for  wounds,  burns,  chilblains,  excoriations,  vari- 
cose veins,  venomous  stings  and  bites,  and  as  a  disinfectant 
in  throat  affections,  leucorrhoea,  diphtheria,  scarlatina,  small- 
pox, ozaena,  etc. 

Dental  Uses. — Phenate  of  soda  is  useful  in  dental  practice, 
as  an  astringent  and  styptic  in  hemorrhage  following  the 
extraction  of  teeth,  and  to  relieve  the  soreness  of  such  an 
operation,  as  it  promotes  the  rapid  absorption  of  the  extrava- 
sated  blood,  and  the  healing  and  hardening  of  the  gums.  It 
is  applied  on  a  pellet  of  cotton,  or  in  solution  with  water,  and 
acts  as  a  sedative  and  antiphlogistic  as  well  as  a  haemostatic, 
and  has  little  or  no  escharotic  action.  For  soft  and  spongy 
gums  it  forms  an  efficient  gargle  or  mouth-wash,  and  can  be 
employed  for  this  purpose  in  its  full  strength,  in  the  form  of 
phenol  sodique,  or  diluted  with  from  one  to  twelve  parts  of 
water.  When  applied  on  cotton,  to  an  exposed  and  inflamed 
pulp,  it  relieves  odontalgia.  It  is  also  employed  in  aphthous 
ulcerations  of  the  mouth,  and  as  a  disinfectant  in  offensive 
breath,  in  the  proportion  of  a  teaspoonful  to  a  glass  of  water. 

DENTAL    FORMUL/E. 
Phenol  Sodique. 

Pure  melted  carbolic  acid 5  parts 

Solution  of  caustic  soda,  specific  gravity  1:332  .    .    .  i   part 

Distilled  water 5  parts. 

Mix. 

A  Phenol  Sodique  Preparation. 

R.        Acidi  carbolici gi-.clxxxviij 

Sodce  caustic gr.xxxj 

Aqu£e ^iv.  M. 

SiGNA. — To  be  applied  on  a  pellet  of  cotton,  or  as  a  mouth  wash,  diluted 
to  meet  requirements  of  case. 

SODII  BICARBONAS— BICARBONATE  OF  SODIUM. 
SESQUICARBONATE  OF  SODIUM. 

Fonmda. — NaHCO-j. 

Derivation. — Bicarbonate  of  Sodium  is  obtained  by  saturat- 
ing the  carbonate  of  sodium  with   carbonic  acid.     It  is  in  the 
33 


514  DENTAL   MEDICINE. 


form  of  a  white,  opaque  powder,  freely  soluble  in  water,  with 
a  mild,  slightly  alkaline  taste. 

Medical  Properties  and  Action. — Bicarbonate  of  sodium  is 
antacid,  alterative,  lithontriptic,  and  from  its  mildness  and 
non-irritating  qualities  is  more  pleasant  to  the  taste  and  to  the 
stomach  than  the  carbonate.  It  is  extensively  used  in  the 
preparation  of  soda  and  seidlitz  powders. 

Therapeutic  Uses. — Bicarbonate  of  sodium  is  internally 
administered  in  neuralgia  connected  with  acidity  of  the  stom- 
ach, cardialgia,  flatulence  and  vomiting,  dyspepsia,  diarrhoea, 
diseases  of  the  skin,  albuminuria,  calculous  disease,  etc.  Ex- 
ternally in  diseases  of  the  skin  of  a  scaly  and  papular  nature, 
ecthyma,  ringworm,  and  sprinkled  over  burns  and  scalds,  and 
combined  with  an  equal  part  of  common  salt,  for  stings  of 
venomous  insects. 

Dose. — Of  bicarbonate  of  sodium,  gr.  v.  to  5j,  in  carbonic 
acid  water,  or  with  sugar  and  mucilage. 

Effervescing  Powders. — Pidveris  Effervescentes  are  com-  ■ 
posed  of  tartaric  acid,  gr.  xxv,  in  one  paper,  and  bicarbonate 
of  sodium,  xxx,  in  another  paper. 

Dental  Uses. — Bicarbonate  of  sodium  is  employed  in  dental 
practice  to  relieve  neuralgia  of  an  acid  origin,  in  which  a  full 
dose  often  proves  very  serviceable  ;  in  aphthae  of  children  it  is 
often  combined  with  a  little  rhubarb  and  proves  very  effica- 
cious. Externally  it  instantly  relieves  odontalgia  when  a 
small  portion  of  the  powder  is  applied  to  the  irritable  pulp 
and  properly  secured.  It  is  also  useful  for  neutralizing  the 
acidity  of  the  oral  fluids,  especially  when  such  a  condition  is 
the  result  of  pregnancy.  It  also  forms  an  antacid  ingredient 
in  dentifrices. 

Dr.  E.  C.  Kirk  recommends  a  thick  paste  of  sodium  car- 
bonate as  a  local  sedative  and  obtundent  of  hypersensitive 
dentine,  its  application  to  be  made  to  a  dry  cavity  and  repeated 
when  necessary.  In  acute  periodontitis,  applied  to  the  gums 
after  a  slight  puncture,  it  will  often  afford  speedy  relief  from 
the  pain.  As  a  chemical  disinfectant  and  antiseptic,  Dr.  Leff- 
mann  considers  sodium  carbonate  to  be  of  great  value  in  the 


BORATE   OF   SODIUM.  515 

treatment  of  devitalized  teeth  containing  semi-putrescent 
pulps  and  food  debris,  to  be  followed  by  injections  of  warm 
water. 

DENTAL   FORMULA. 
For  Periodontitis ^  etc. 

Carl  Seiler. 

R  .        Sodii  bicarb ^  viij 

Sodii  bibor 3  viij 

Sodii  Benzoate 

Sodii  salicylate aa  gr.xx 

Eucalyptol 

Thymol aa  gr.  x 

Menthol gr.v 

01.  gaultheria g't.vj 

Glycerine ^viiiss 

Alcoholis ^ij 

Aquse q.  s.  1 6  pints.      M. 

SiGNA. — Use  as  an  antiseptic  spray. 

SODII  BORAS— BORATE  OF  SODIUM. 
BORAX. 

Formula. — Na2B407  +  10H2O. 

Source. — Borax  is  a  native  salt,  but  can  be  obtained  artifi- 
cially by  boiling  together  native  boracic  acid  (found  in  Italy), 
and  carbonate  of  soda.  California  furnishes  the  borax  used  in 
this  country.  It  is  in  the  form  of  colorless  crystals,  which 
effloresce  somewhat  in  dry  air,  and  are  freely  soluble  in  water 
and  glycerine,  but  insoluble  in  alcohol,  with  an  alkaline  reac- 
tion, and  a  sweetish  alkaline  taste.  It  dissolves  fibrine,  albu- 
men, casein  and  uric  acid. 

Medical  Properties  and  Action. — Borax  is  refrigerant,  diuretic, 
detergent,  antacid  and  emmenagogue,  and  has  been  employed 
as  a  solvent  for  calculi.  It  resembles  in  its  action  carbonate  of 
soda,  and  by  its  mild  alkaline  qualities  it  improves  the  condi- 
tion of  the  skin  and  mucous  membranes.  In  excessive  or 
large  repeated  doses  it  is  injurious,  causing  nausea  and  vomit- 
ing, and  a  scorbutic  condition  of  the  body. 

llierapciitic  Uses. — Borax  is  internally  administered  in  infan- 
tile diarrhoea,  in  the  form  of  an  enema;  also  as  a  solvent  for 


516  DENTAL  MEDICINE. 


calculi,  and  in  dropsy,  etc.,  but  its  chief  use  is  as  an  external 
application.  Externally  it  is  applied  as  a  detergent  in  cutane- 
ous affections,  ulcerations,  pityriasis,  to  remove  freckles,  to  allay 
itching,  etc.,  etc. 

Dose. — Of  borate  of  sodium,  gr.  ij  to  3j. 

Glycerite  of  Borate  of  Sodium — GlyceritwnSodiiBoratis 
— Glycerinum  Boracis — is  composed  of  borax,  oij ;  glycerine, 
Oss,  and  is  a  useful  application  to  the  mouth  and  throat. 

Honey  of  Borate  of  Sodium — Mel  Sodii  Boratis — Mel 
Boracis — is  composed  of  borax,  .5j ;  clarified  honey,  Sj,  and 
is  also  useful  as  a  detergent  application  to  the  mouth  and 
throat. 

Boricine. — Boricine  is  a  combination  of  equal  parts  of  borax 
and  boracic  acid,  forming  a  tetraborate  of  sodium,  which  is 
neither  toxic,  caustic,  nor  irritant.  It  has  no  odor,  and  gives 
a  saturated  solution  at  i6  per  cent.  Mr.  Emile  Denis  recom- 
mends boricine  as  a  disinfectant  of  root-canals,  abscess  of 
antrum,  and  diseased  mucous  membrane. 

Dental  Uses. — Borax,  mixed  with  sugar  or  honey,  is  a  very 
useful  application  for  aphthae  and  other  ulcerations  of  the 
mouth,  for  which  it  may  be  mixed  with  sugar  in  the  propor- 
tion of  one  part  to  seven,  or  in  the  form  of  inel  boracis.  In 
mercurial  stomatitis,  an  aqueous  solution  of  borax,  or  the  niel 
boracis,  forms  an  efficient  gargle.  Borax  is  also  a  useful  appli- 
cation in  fissured  or  cracked  tongue.  Borax  is  also  added  to 
sage  and  balm  teas,  to  form  gargles. 

In  the  dental  laboratory,  borax  is  employed  as  a  flux  in 
melting  metals,  such  as  gold  and  silver,  and  in  the  process  of 
soldering  metals.  It  is  also  employed  to  harden  plaster  casts 
or  models,  the  model  being  well  dried  and  then  immersed  for 
a  few  minutes  in  a  solution  of  borax  in  boiling  water,  which 
renders  it,  when  cool,  hard  and  durable.  (Solutions  of  carbon- 
ate of  soda  and  alum  are  used  for  the  same  purpose).  Dr.  J. 
L.  Williams  considers  borax  a  valuable  application  to  the 
teeth  of  pregnant  women  to  counteract  acidity  of  the  fluids  of 
the  mouth.  He  recommends  the  use  of  the  powder  applied  to 
the  teeth  and  allowed  to  remain  half  a  minute  or  so,  and  then 


SALICYLATE   OF   SODIUM.  517 

brushed   off  by  a  whirling   motion    of  the  brush,  not  with   a 
horizontal  movement.      Also  useful  to  sterilize  instruments. 

Impression  trays  may  be  perfectly  cleaned,  after  using  model- 
ing composition,  by  boiling  in  sal-soda  water. 

DENTAL    FORMUL.B. 

A  Mild,  Detergent  Gargle.  For  Fissw-ed  or  Cracked   Tongue. 

R.    Sodii    biboratis   .    .    .   ^j  R.    Sodii  biboratis     .    .    .   ^j 

Glycerini 3VJ.        M.  Glycerini gj.  M. 

E-         ^xz.^7  TTi        ^-  D         V  To  be  used  as  a  lotion  or  gargle. 

For    Aphthous    Ulcerations,    Parasitic 

Formations,  and  Diphtheritic  Condi-  p^y  Fissured  Tongue. 

lions. 

J.  W.  White. 

R.    Sodii  biboratis     .    .  .    zij  t^      ^    ■>•-,•,         •                        1 

„         .              ..  .  R.    Sodii  biboratis     .    .    .   gr.xl 

Svrupi  aurantn    .    .  .    Ziv  _,         .                             Z- 

,      .,,  _.  -,                 Glycerini X\ 

Aqu£E destillatae  .    .  .    ±w.  M.                    ^              .„                   :^.             ^, 

_,    ,            ,.    ,  ,     .  Aquae  destillatae    .    .    §1%'.          M. 

SiGNA. — To  be  applied  as  a  lotion  or  t?         j                    i 


mouth  wash,  stimulant  and  antiseptic.  *    * 

For  Aphthous  Ulcerations,  etc.,  etc.  A  Detergent  Alkaline  Gargle. 

R.    Sodii  sulphitis    .    .    .  jj  R.^ Sodii  biboratis   .    .    .  ^iv 
Glycerini      .....   5J.           M.  Glycerini, 

SiGNA. — To   be   used   as    a    lotion    or  Tincturae  myrrhje    .  aagss 

mouthwash.  AquiS  destillatse  .  .    .   5  x.  M. 

SODII    SALICYLAS— SALICYLATE  OF  SODIUM. 

Formula.— 2^z.Q'jY{f)^^  HoO. 

Derivation. — Salicylate  of  Sodium  is  prepared  by  the  addi- 
tion of  salicylic  acid  to  a  solution  of  bicarbonate  of  sodium ; 
when  the  latter  is  in  excess  the  solution  is  brownish  or  purplish 
in  color,  and  has  a  strong  odor  of  wintergreen.  The  formula 
is  as  follows:  II.  Acidi  salicylici,  oij ;  sodii  bicarb., 3j  ;  aquae, 
5ij.     M. 

Dose. — A  teaspoonful  every  2,  3  or  4  hours. 

Dental  Uses. — Employed  as  an  internal  remedy  for  odon- 
talgia, periodontitis  and  the  pain  of  carious  dentine,  affording 
temporary  relief  for  several  days.  Dr.  Thomas  recommends 
doses  often  grains  every  half-hour  for  the  relief  of  odontalgia. 

For  Aphthous  Stomatitis. 

R  .        Salicylate  of  soda 20  parts 

Distilled  water 100  parts  dissolve. 

SiGNA. — Paint  the  inflamed  parts  five  or  six  times   a  day,  particularly  after 
meals.    The  mouth  should  previously  be  well  rinsed  out  with  tepid  water. 


518  DENTAL   MEDICINE. 


SODII  SULPHIS— SULPHITE  OF  SODA. 

Formula. — Na2S  O3+ 7  H2O . 

Derivation. — Sulphite  of  Soda  is  prepared  by  passing  sul- 
phurous acid  into  a  solution  of  carbonate  of  soda,  and  evapo- 
rating free  from  air.  The  sulphurous  acid  unites  with  the 
soda  of  the  carbonate,  to  form  the  sulphite  of  soda,  and  the 
carbonic  acid  escapes.  On  cooling,  the  salt  crystallizes  in 
white  prismatic  crystals,  and  should  be  kept  well  stoppered,  as 
it  changes  on  exposure  into  sulphate  of  soda. 

Medical  Properties  and  Action. — Sulphite  of  soda  is  a  disin- 
fectant and  deodorizer,  and  its  action  and  uses  are  similar  to 
those  of  the  other  sulphites,  hyposulphites  and  sulphurous 
acid. 

Dose. — Of  sulphite  of  soda,  gr.  xv  to  5j,  three  times  a  day. 

Dental  Uses. — Sulphite  of  soda  is  sometimes  employed  in 
the  form  of  a  lotion  for  aphthous  sore  mouth  due  to  a  para- 
sitic vegetable;  also  in  ulcerous  stomatitis,  gangrenous  stoma- 
titis, and  all  suppurative  affections  of  mucous  membrane, 
especially  when  they  are  sustained  by  zymotic  influences  or 
invisible  organisms.  Dr.  E.  C.  Kirk  has  successfully  employed 
sulphite  of  soda  in  combination  with  boracic  acid,  for  bleach- 
ing discolored  teeth.  (See  Formula.)  His  method  is  as  follows  : 

Having  adjusted  the  rubber  dam  to  the  tooth  to  be  treated, 
and  one  adjoining  it  on  each  side,  the  cavity  of  decay  is 
cleansed  of  all  debris  and  the  root  filled  with  gold  or  gutta 
percha  for  one-half  its  length.  The  powder,  composed  of  sul- 
phite of  soda  and  boracic  acid,  is  packed  into  the  remaining 
portion  of  the  pulp  canal  and  cavity  of  decay,  leaving  just 
sufficient  space  to  insert  a  temporary  filling  of  gutta  percha  or 
Hill's  Stopping.  After  the  powder  has  been  properly  packed, 
a  drop  of  water  is  permitted  to  fall  upon  it  from  a  drop-tube 
or  a  pellet  of  cotton  wrapped  around  a  broach,  the  object 
being  to  dampen  the  powder,  not  to  wash  it  out.  The  cavity 
of  decay  is  then  filled  with  gutta  percha,  and  the  patient  dis- 
missed until  the  next  sitting,  when  a  second  application  can 
be  made,  which  is  usually    vifificient,  except  in  cases  where  the 


SODIUM  SILICO-FLUORIDE.  519 


walls  of  the  tooth  are  very  thick  and  much  discolored,  when 
a  third  application  may  be  necessary.  When  the  water  is 
added  to  the  powder  a  chemical  reaction  takes  place,  the 
boracic  acid  unites  with  the  sodium  of  the  sulphite  to  form 
sodium  borate,  at  the  same  time  liberating  the  sulphurous 
acid,  upon  which  the  bleaching  powder  depends. 

DENTAL    FORMULAE. 

For  Aphthuus  Sore  Mouth.  For  Satne. 

Wallace 
R.    Sodii  sulphitis    .    .    .  3J  ^      sodii  sulphitis    .    .'  .   gr.xxx 

•-^^^^ foJ-         M.  Glycerinse, 

SiGNA. — Apply  as  a  lotion.  Aquae aa  ^  ss. 

SiGNA. — To  be  used  on  a  swab  every 
two  hours. 
For  Bleaching  Discolored  Teeth. 
E.  C.  Kirk. 

R.        Sodii  sulphitis gr.  loo 

Acidi  boracis gr.70 

Mix  by  grinding  together  in  a  warm,  dry  mortar,  to  a  fine  powder, 
which  is  preserved  in  an  air-tight  stoppered  bottle,  and  kept  in  a 
dry  place. 

SiGNA. — (See  Dental  Uses  of  Sulphite  of  Soda.) 

SODIUM  SILICO-FLUORIDE. 

Derivation. — When  sand  is  fused  with  sodium  or  potassium 
carbonate,  a  reaction  occurs  forming  a  silicate  of  these  metals, 
Si02+Na2C03=Na2Si02  (sodium  silicate)  +  CO2.  The  silicates 
of  sodium  and  potassium  are  commonly  known  as  water-glass, 
and  are  soluble  in  water,  whereas  silicates  of  other  metals  are 
generally  insoluble.  When  a  mixture  of  fluor-spar  and  any 
silicious  substance,  as  sand,  is  heated  in  a  retort  with  HoSO^; 
the  resulting  gas  being  distilled  over  through  mercury  into 
water,  which  holds  it  in  solution,  and  which  is  then  filtered 
to  remove  the  free  silicon  which  precipitates,  the  result  is 
hydro-fluosilicic  acid. 

Medical  Properties  and  Therqpeutic  Uses. — Sodium  silico- 
fluoride,  in  the  form  of  a  white  powder,  is  antiseptic,  disinfect- 
ant and  styptic.  Experiments  with  this  salt  by  Mr.  Wm. 
Thomson,  F.  B.  F.  C,  F.  C.  S.,  showed  that  the  compounds 


.520  DENTAL   MEDICINE. 


of  fluorine  were  powerful  disinfectants,  and  of  these  the  sodium 
silico- fluoride  was  the  most  serviceable.  It  has  been  employed 
as  a  substitute  for  peroxide  of  hydrogen  on  account  of  the 
changeable  nature  of  the  latter  agent.  Even  in  a  saturated 
solution,  sodium  silico-fluoride  is  not  an  escharotic  coagulant, 
but  it  is  a  slight  irritant  in  such  a  form,  which  is  not  a  positive 
disadvantage  in  the  treatment  of  some  affections,  such  as 
alveolar  pyorrhoea  for  example. 

Dental  Uses. — Sodium  silico-fluoride  has  been  used  with 
good  results  in  cases  of  putrescent  pulps,  chronic  alveolar 
abscesses,  pyorrhoea  alveolaris.  Also  as  a  deodorizer  in 
pulp  canals  by  destroying  the  putrescent  hydrogen.  As  a 
disinfectant,  it  is  powerful  enough,  even  in  weak  solu- 
tion to  antagonize,  in  a  marked  degree,  the  germs  of 
putrefaction;  as  a  coagulant,  it  is  non-escharotic ;  as  a  de- 
odorant, it  is  strong  enough  to  destroy  the  most  penetrating 
of  putrefactive  odors;  as  a  stimulant,  it  is  powerful  enough  in 
full  solution  to  bring  about  the  formation  of  new  tissue,  and 
not  act  as  an  irritant  to  surrounding  tissue  ;  it  is  comparatively 
unchangeable.  Such  properties  may  render  it  one  of  the 
most  useful  salts  in  the  dental  pharmacopoeia. 

STENOCARPINE,  or  GLEDITSCHINE. 

Stenocarpine  is  an  alkaloid  obtained  from  the  tree  Gleditschia 
triacantluLS.  As  a  local  anaesthetic,  Dr.  Herman  Knapp,  in  his 
experiments  as  to  its  physiological  action,  found  it  to  be  fully  as 
energetic  as  a  cocaine  solution  of  equal  strength  in  producing 
anaesthesia  of  the  cornea  and  conjunctiva.  Dr.  Jackson  found 
that  the  installation  of  one  drop  of  a  two  per  cent,  solution  of 
stenocarpine  caused  a  slight  smarting,  followed  by  dryness  of 
the  conjunctiva,  dilatation  of  the  pupil,  and  within  two  and  a 
half  minutes  complete  anaesthesia  of  the  conjunctiva  and  cor- 
nea, lasting  for  about  twenty  minutes.  These  results  were 
obtained  in  sixteen  different  individuals,  in  all  complete  anaes- 
thesia being  obtained  in  one  or  two  minutes,  and  passing  off 
mostly  within  half  an  hour.  Stenocarpine  also  appears  to  pro- 
duce a  wider  dilatation  of  the  pupil  than  other  local  anaesthetics 


STROPHANTIIUS.  521 

used  upon  the  eye.  Applied  to  mucous  membrane  of  the  nose, 
throat,  etc.,  anaesthesia  can  be  readily  produced  to  an  equal,  if 
not  more  marked,  degree  than  can  be  obtained  by  the  employ- 
ment of  a  solution  of  cocaine  of  equal  strength  ;  and  when  ap- 
plied to  the  throat  or  nose  the  senses  of  taste  and  smell  are 
respectively  suspended.  Applied  to  the  skin  externally,  it 
causes  complete  anaesthesia,  the  method  of  application  being 
to  simply  moisten  the  surface,  and  keep  it  continually  moist 
with  the  solution,  when,  after  ten  minutes,  a  needle  may  be 
plunged  into  the  skin  without  the  slightest  sensation.  To 
produce  painless  operations  on  the  healthy  skin,  the  incisions 
must  pass  but  gradually  through  the  skin,  and  as  each  layer 
is  divided,  the  wound  must  be  freely  moistened  with  the  solu- 
tion. As  regards  the  toxicological  action  of  stenocarpine 
when  given  in  large  doses,  the  nature  of  the  symptoms  of 
poisoning  which  it  produces  does  not  appear  to  be  as  yet 
clearly  established.  Dr.  Knapp  states  that  its  action  is  analo- 
gous to  strychnine,  while  Dr.  Jackson  describes  stenocarpine 
as  a  depressor  motor  poison,  and  in  no  case  in  his  experi- 
ments does  he  refer  to  the  production  of  convulsions.  As  far 
as  has  yet  been  determined,  the  physiological  action  of  steno- 
carpine appears  to  be  closely  similar  to  that  of  cocaine. 

STROPHANTHUS— STROPHANTHUS  HISPIDUS. 

Source. — Strophanthus  is  derived  from  the  climbing  plant 
strophanthus  hispid  us  (Apocynaceae)  of  western  Africa,  from 
the  extract  of  which  the  arrow-poison  Kombe  is  made  by  the 
natives.  The  active  principle  is  StrophantJiiii,  from  which 
Stropliantliidin  is  derived  by  the  action  of  sulphuric  aci'l. 
Strophanthin  is  a  crystallizable  glucoside,  common  to  different 
parts  of  the  plant,  but  especially  in  the  seeds  which  yield  a 
large  proportion. 

Medical  Properties  and  Therapeutic  Uses. — Strophanthin  is 
bitter,  acidulous,  insoluble  in  ether  and  chloroform,  but  soluble 
in  alcohol  and  water.  It  is  a  local  anaesthetic,  as  three  or  four 
drops  of  a  solution  of  i  to  lOOO  dropped  into  the  cornea  will 
anaesthetize   it   for  one  or  two  hours  without  any  irritation  of 


522  DENTAL  MEDICINE. 


the  conjunctiva.  It  is  considered  to  be  a  more  powerful  local 
anaesthetic  than  cocaine.  The  sensation  of  heat  and  cold  is 
the  last  to  be  overcome  and  the  first  to  revive.  Strophanthus 
is  a  cardiac  tonic,  in  its  action  resembling  digitalis.  It  lessens 
the  heart's  action,  lengthens  the  intervals  between  the  con- 
tractions, and  increases  the  energy  of  the  muscular  tissue.  In 
fatal  cases  the  heart's  action  is  arrested  in  diastole.  It  is  also 
to  some  degree  a  diuretic,  and  the  prolonged  use  of  strophan- 
thus will  sometimes  cause  diarrhcea.  Besides  its  employment 
as  a  local  anaesthetic  it  is  administered  in  cardiac  dropsy,  as  a 
cardiac  stimulant  in  typhoid  fever,  also  in  angina  pectoris, 
bronchial  asthma,  whooping-cough,  etc. 

Dose. — Of  the  tincture — tinctura  strophanthi  (5  per  cent.), 
TTLij  to  XV ;  of  strophanthin,  gr.  i-iooo  to  1-60.  Strophanthin 
may  also  be  administered  hypodermically  in  doses  of  gr.  tttt, 
not  more  than  once  daily. 

Dental  Uses. — Strophanthin  is  employed  in  dental  practice 
as  a  local  anaesthetic  and  obtunder  of  hypersensitive  dentine. 
As  a  local  anaesthetic  it  is  usually  combined  with  cocaine, 
atropine,  some  of  the  essential  oils  and  glycerine. 

DENTAL    FORMULA. 

For  Local  AncBsthesia. 

Dr.  Birge. 

U .        Strophanthin gr.^ 

Sulphate  atropin gr.i 

Carbolic  acid  (95  per.  cent,  sol.) gtts.v 

Hydrochlorate  of  cocaine grs.xx 

Distilled  water q.  s.  f^j.  M. 

SiGNA. — Inject  4  to  6  drops  hypodermically. 

SULFONAL— SULPHONAL. 

Formula. — Q^jYi^i^^ ^{QYi^^,'-  C:  (S02C2H5)2. 

Sulfonal  is  in  the  form  of  colorless  prisms,  odorless  and 
tasteless.  It  is  easily  soluble  in  hot  water  and  in  alcohol,  and 
but  slightly  soluble  in  cold  water,  and  melts  at  258°  F.  It 
appears  to  possess  hypnotic  properties  of  considerable  power, 
and  is  regarded  as  prompt  and  reliable,  producing  a  quiet, 
natural  sleep,  lasting  a  number  of  hours.     It  appears  to  have 


SULPHONAL.  523 

no  unfavorable  effects  on  the  heart  or  the  circulation,  nor  on 
the  temperature,  the  pulse  or  the  respiration,  and  to  produce 
no  disagreeable  secondary  symptoms,  nor  to  interfere  with  the 
process  of  digestion. 

It  is  best  administered  in  hot  liquids,  such  as  a  bowl  of 
soup  or  broth,  a  cup  of  milk,  tea,  coffee,  cocoa,  etc. 

The  conclusions  drawn  by  Mathes  are  as  follows:  i.  Sul- 
fonal  is  a  useful  hypnotic  agent,  though  it  is  not  always  effica- 
cious. 2.  It  has  the  advantage  over  other  agents  of  having 
no  odor  or  taste,  and  no  influence  on  the  essential  organs  of 
life.  3.  The  worst  of  its  disagreeable  effects  are  insignificant. 
4.  The  dose  depends  upon  the  individual  susceptibility,  and  is 
therefore  variable.  Generally  a  gramme  is  sufficient  to  cause 
sleep  without  accessory  manifestations.  When  these  are  pro- 
duced the  dose  should  be  diminished.  On  account  of  its 
slow  action,  it  should  be  given  at  least  an  hour  before  the 
time  for  sleep.  5.  When  the  insomnia  is  due  to  irritating 
cough  or  to  pains  not  clearly  neuralgic,  the  use  of  sulfonal  is 
contra-indicated.  In  most  true  neuralgias,  on  the  contrary,  it 
may  be  used  with  benefit. 

It  is  a  valuable  remedy  for  persistent  neuralgia  in  doses  of 
gr.  X— xxx;  it  may  be  administered  in  hot  liquids  such  as  tea, 
in  the  form  of  tablets  of  five  and  fifteen  grains.  Dr.  Chase 
recommends  sulphonal  very  highly  for  nervous  patients  after 
a  protracted  dental  operation,  as  a  small  dose  will  give  a  quiet 
night's  rest. 

Dose. — Grs.  v  to  grs.  xxx ;  but  variable,  depending  upon 
the  individual  susceptibility. 

Although  sulphonal  is  probably  one  of  the  safest,  as  it  is 
one  of  the  most  efficacious  among  the  recent  hypnotics,  the 
series  of  cases  published  by  Bresslaur,  of  Vienna,  show  clearly 
that  it  has  certain  dangers.  Out  of  seventy-seven  feeble 
lunatic  patients  who  were  treated  with  this  drug,  no  less  than 
seven  showed  serious  symptoms,  and  in  five  of  these  there  was 
a  fatal  termination ;  but  it  should  be  stated  that  the  patients 
had  been  taking  the  drug  for  a  considerable  time  in  good 
doses,  and  had  borne  it  well   until  symptoms  of  disturbance 


\ 

524  DENTAL  MEDICINE. 


appeared,  such  as  great  constipation,  dark -brown  urine,  slow- 
but  in  some  cases  rapid  but  feeble  pulse,  discolored  patches 
resembling  purpura  on  the  limbs,  and  great  prostration.  In 
the  cases  which  ended  fatally,  the  cause  of  death  was  heart- 
failure,  with  oedema  of  the  lungs. 

The  action  of  sulphonal  upon  digestion  is  as  follows  : 

a.  Strong  solutions,  saturated  or  half  saturated,  considerably 
delayed  digestion,  and  that  the  stronger  the  solution  the  greater 
was  the  retardation. 

b.  Weak  solutions,  such  as  tV  or  3^  of  a  saturated  solution, 
had  little  effect  either  in  accelerating  or  delaying  digestion, 
but  when  i^  of  a  saturated  solution  was  employed,  delay  in 
digestion  took  place. 

c.  Strong  or  weak  solutions  had  no  marked  effect  in  re- 
tarding putrefaction. 

TERCHLORIDE   OF  PHENOL. 

Derivation. — Terchloride  of  Phenol  has  recently  been  intro- 
duced as  a  disinfectant  and  antiseptic.  It  is  prepared  by 
passing  a  stream  of  chlorine  gas  through  chemically  pure 
carbolic  acid,  previously  melted,  until  it  acquires  a  violet 
hue.  When  carbolic  acid  is  acted  upon  by  chlorine  gas  a 
number  of  compounds  are  produced ;  such  as  a  mono- 
chloride,  a  bichloride  and  a  tri-  or  ter-chloride  of  carbolic 
acid  (phenol). 

Medical  Properties  and  Action. — It  is  not  an  irritant,  and  has 
no  acid  reaction. 

Therapeutic  and  Dental  Uses. — Terchloride  of  phenol  is 
claimed  to  be  a  valuable  antiseptic  and  disinfectant  in  the 
treatment  of  gangrenous  ulcers,  etc.  In  dental  practice  it  has 
been  very  recently  recommended  in  combination  with  iodo- 
form, as  a  material  for  capping  exposed  pulps  and  as  a  filling 
for  root  canals  of  teeth,  and  the  advantages  claimed  for  it  are, 
that  it  will  be  resorbed  when  in  contact  with  living  tissues  ; 
it  is  easily  introduced  into  pulp  canals;  it  absorbs  exudations; 
it  becomes  hard  when  mixed  with  certain  chemical  substances, 
but  is  destroyed  by  pus  ;    it  is  a  very  bad   conductor  of  heat; 


TURPENTINE.  525 


and  it  is- absolutely  a  non-irritant.  The  method  recom- 
mended for  its  use  as  a  capping  and  filling  material  is,  to 
incorporate  iodoform  and  terchloride  of  phenol  with  decal- 
cified dead  bone,  as  follows  :  dead  bone  or  ivory  shavings 
are  decalcified  in  a  ten  per  cent,  solution  of  chemically  pure 
hydrochloric  acid,  and  after  all  the  lime  salts  are  extracted,  the 
residue  is  collected  upon  a  filter,  washed,  dried  and  rubbed 
to  a  fine  powder  in  a  porcelain  or  glass  mortar.  Upon  this 
powder  ten  times  its  weight  of  a  ten  per  cent,  solution  of 
iodoform  in  sulphuric  ether  is  gradually  poured  and  constantly 
rubbed  until  a  fine  yellow  powder  is  obtained,  which  contains 
about  fifty  per  cent,  of  iodoform.  When  used  as  a  capping 
for  pulps,  or  a  filling  material  for  root  canals  of  teeth,  this 
powder  is  made  into  a  paste  by  the  addition  of  carbolic  acid 
or  terchloride  of  phenol,  being  worked  or  rubbed  together 
like  ordinary  cement.  For  hypersemic  conditions  of  the  den- 
tal pulp  success  has  attended  the  application  of  a  cap  of  the 
iodoform  and  decalcified  bone  paste  mixed  with  terchloride  of 
phenol.  For  inflamed  pulps  the  application  of  terchloride  of 
phenol  is  to  be  repeated  every  third  or  fifth  day,  until  no  more 
pain  is  felt,  and  the  pulp  is  then  to  be  capped  with  the  decal- 
cified bone,  iodoform  and  terchloride  of  phenol  material,  and  a 
temporary  filling  introduced  into  the  crown  cavity.  The  treat- 
ment of  ulcerated  and  gangrenous  pulps  of  teeth  consists  in 
treating  with  the  terchloride  of  phenol,  and  after  the  second 
or  third  application,  if  no  trouble  occurs  from  a  temporary 
closure  of  the  root  canals,  to  fill  with  the  decalcified  bone, 
iodoform  and  terchloride  material,  using  whalebone  instru- 
ments for  its  introduction,  until  congelation  is  occasioned,  and 
the  congested  condition  of  the  capillaries  of  the  part  relieved, 
acting  as  a  counter-irritant  and  antiphlogistic. 

TEREBINTHINA— TURPENTINE. 

Source. — The  concrete  oleo-resin  of  Piiins  australis  and  vari- 
ous species  of  pine. 

Oleum  TerebiutJiincB. — Oil  of  Turpentine  obtained  by  distil- 
lation. 


526  DENTAL   MEDICINE. 


Formula. — CmHig. 

Oil  of  Turpentine  is  a  limpid,  volatile,  colorless  oil,  with  a 
hot  pungent  taste  and  a  strong  peculiar  odor.  It  is  slightly 
soluble  in  water.  In  small  doses  it  increases  the  action  of  the 
heart,  elevates  the  arterial  tension  and  causes  a  sense  of  warmth 
and  exhilaration. 

In  large  doses  it  causes  thirst,  fever,  vomiting,  weakness, 
and  a  species  of  intoxication.  In  poisonous  doses  there  is 
complete  muscular  relaxation,  insensibility,  flushed  face,  dila- 
ted pupils,  labored  and  stertorous  breathing.  It  stimulates 
the  vaso-motor  system,  and  has  marked  antiseptic  properties, 
arresting  fermentation  and  putrefaction,  and  destroying  micro- 
organisms. Inhalation  of  the  vapor  of  turpentine  causes 
'headache,  nasal  and  bronchial  irritation,  ecchymosis  of  the  air- 
passages,  hyperaemia  of  the  kidneys  and  congestion  of  the  lungs. 

The  ozonized  oil  of  turpentine  is  an  antidote  to  phosphorus, 
by  the  power  it  possesses  of  converting  the  agent  into  an 
insoluble  substance ;  and  a  vial  of  turpentine  worn  about  the 
neck  prevents  necrosis  of  the  jaw  and  steatosis  in  workmen 
using  phosphorus  in  manufactories. 

Sanitas  is  a  highly  ozonized  preparation  of  turpentine,  and  is 
used  as  an  antidote  to  phosphorus  poisoning.  (See  oil  of  Sanitas.) 

Oil  of  turpentine  is  employed  in  flatulence,  colic,  chronic 
intestinal  catarrh,  constipation  and  as  an  anthelmintic  ;  also  in 
passive  hemorrhages  from  mucous  surfaces,  taenia  and  as  a 
stimulant  in  low  fevers.  In  the  form  of  enemata  for  colic, 
tympanitic  distension  and  impaction  of  faeces,  etc. ;  in  the  form 
of  liniment  for  myalgia,  neuralgia,  lumbago,  etc.  ;  also  for 
burns,  erysipelas  and  chilblains. 

Terebinthene. — (CioHjg)  is  a  hydrocarbon  formed  by  the  dis- 
tillation of  turpentine  with  an  alkali.  Terebinthene  is  con- 
verted by  hydration  into  a  solid  crystalline  body,  known  as 
terpine ;  and  terpine  is  converted  into  tei^pinol  by  an  acid. 
Terebene  is  derived  from  turpentine  by  the  action  of  sulphuric 
acid.  These  derivations  are  used  in  bronchitis,  broncho-pneu- 
monia, asthma,  etc.  In  dental  practice  terpinol  is  employed  as 
an  antiseptic,  disinfectant  and  sterilizer. 


TURPENTINE.  527 


Dose. — Oil  of  turpentine,  TTLv  to  Sss  ;  of  terebinthene-ter- 
pine,  gr.  v  to  gr.  xx;  of  terpinol,  gr.  ij  to  gr,  v;  of  terebene, 
mv  to  XX. 

Lmiinentiim  TerebinthincB. — Liniment  of  Turpentine  is  com- 
posed of  oil  of  turpentine  thirty-five  parts  and  resin  cerate 
sixty-five  parts. 

Oil  of  Sanitas — Oleum  Sanitas,  is  obtained  by  the  oxidation 
of  oil  of  turpentine  floating  on  water,  by  directing  a  stream 
of  heated  air  on  its  surface.  Sanitas  oil  is  an  antiseptic  and 
disinfectant,  possessing  considerable  oxidizing  power.  It  is 
non-irritant  and  non-poisonous,  and  its  odor  is  similar  to  that 
of  fresh  pine.  The  oils  of  cinnamon,  gaultheria  and  sassafras 
will  disguise  its  odor.  In  dental  practice,  the  oil  of  sanitas  has 
been  very  successfully  employed  in  alveolar  pyorrhoea,  alveolar 
abscess,  diseases  of  mucous  membrane,  exposed  pulps,  abscess 
of  the  antrum,  foul  ulcers,  wounds  and  ulcerated  sore  throat ; 
also  as  a  protection  against  phosphorus  poisoning  and  phos- 
phor-necrosis of  the  jaw. 

The  oil  of  turpentine  is  employed  as  a  styptic  in  dental  hemor- 
rhage, applied  on  cotton  after  the  loose  clot  is  removed  and  the 
cavity  thoroughly  washed  out  with  hot  water.  For  hemorrhage 
following  the  removal  of  single  root  teeth,  it  is  recommended 
to  wrap  the  root  of  the  extracted  tooth  with  a  few  shreds  of 
cotton  saturated  with  oil  of  turpentine  and  return  it  to  its  cavity. 

Oil  of  turpentine  is  also  employed  as  a  sterilizer  of  surgical 
and  dental  instruments,  gauze,  bandages,  towels,  etc.  The 
method,  which  is  simple,  consists  in  placing  the  oil  of  turpen- 
tine in  flat,  large-mouthed  bottles  at  the  bottom  of  each  case 
or  drawer,  the  volatility  of  the  agent  causing  the  vapor  to 
impregnate  the  surrounding  air. 

For  Dental  Hemorrhages  from   Constitutional  Vice. 

Mr.  Salter. 
JJ  .        Vitelli  ov ij 

Olei   terebinth gjss 

Tinct.  ferri  ses  chloride ^iij 

Sacchari ^ij 

Aqufc 5^'iij-  M. 

Dose :  A  teaspoonful  every  hour. 


528  DENTAL   MEDICINE. 


THYMOL. 

Foniiitla. — CioHi3(OH). 

Derivation. — Thymol,  or  thymic  acid,  is  obtained  from  the 
herb  tJiynius  vulgaris,  or  common  thyme,  which  is  cultivated 
in  this  country  for  the  same  purpose  as  sage,  lavender,  etc. 
Thyme  yields  a  volatile  oil,  olemn  thynii,  from  which  thymol 
or  thymic  acid,  is  obtained  by  treating  the  oil  with  an  aqueous 
solution  of  potassa  or  soda,  which  separates  it  from  a  principle 
called  thymene,  with  which  it  is  mixed  in  the  oil,  and  which  is 
not  affected  by  the  alkalies.  The  thymate  thus  formed  is 
decomposed  by  an  acid,  and  the  liberated  thymol,  or  thymic 
acid,  is  purified  by  repeated  washings,  desiccation  and  distil- 
lation. Thymol  is  in  the  form  of  aromatic  white  crystals, 
soluble  in  one  thousand  parts  of  hot  water. 

Medical  Properties  and  Action. — In  a  concentrated  state, 
thymol  has  an  acrid  and  caustic  taste ;  but  when  very  much 
diluted,  the  only  taste  experienced  is  that  of  thyme. 

Thymol  has  acrid  properties,  and  is  similar  in  its  action  to 
carbolic  acid.  It  imparts  a  sense  of  coolness  to  the  mouth, 
like  that  of  oil  of  peppermint,  and  when  once  melted  it  re- 
mains indefinitely  in  the  liquid  state. 

While  it  is  only  slightly  soluble  in  water,  it  is  freely  soluble 
in  alcohol,  and  is  dissolv^ed  by  ether  and  the  fixed  oils.  The 
alkalies  unite  with  it  to  form  soluble  salts.  Like  creasote,  it 
has  the  property  of  combining  with  animal  tissues,  and 
thus  prevents  putrefaction.  While  it  has  the  important  prac- 
tical properties  of  carbolic  acid,  it  is  free  from  disagreeable 
odor,  and  it  is  claimed  to  be  as  efficient  an  antiseptic  as  that 
agent. 

Therapeutic  Uses. — Thymol  is  almost  exclusively  employed 
as  an  external  application,  and  is  often  substituted  for  the  oil 
of  origanum,  which  is  obtained  from  the  common  marjoram. 
It  is  considered  to  be  a  valuable  antiseptic  and  antifermenta- 
tive  agent. 

Dental  Uses. — Thymol,  when  combined  with  glycerine,  in 
a  form  known  as  Glycei  ole  of  Thymol,  is  a  valuable  antiseptic 


THYMOL. 


529 


in  the  treatment  of  suppurating  pulps  of  teeth,  as  a  dressing 
for  ulcers  of  the  mouth,  wounds,  etc. ;  also,  in  the  treatment 
of  teeth  after  the  devitalization  of  the  pulp,  chronic  inflamma- 
tion of  the  pulp,  and  alveolar  abscess,  as  it  arrests  the  putre- 
factive process  ;  also  in  stomatitis  and  abrasion  of  mucous 
membrane.  Hartmann  recomrpends  sprinkling  crystallized 
thymol  on  an  exposed  (not  bleeding)  pulp,  to  relieve  the  pain 
of  pulpitis. 


DENTAL    FORMULAE. 


Glycerole  of  Th] 

v/nol. 

R. 

Thymolis  (cryst.)    . 
Glycerini, 

.  gr.xx 

Alcoholis    .    .    .    .aaf^j 

Aquae  destillatse     . 

.  Oj.           M. 

For 

Alveolar     Abscess, 
Pulps,  etc. 

Alvin. 

Suppurating 

R. 

Thymolis  (cryst.)  . 

■  Pto-J 

lodi 

.  ptm.j 

Potassii  iodidi  .  .    . 

.  ptm.j 

Glycerini     .... 

.  ptS.  V  to  XV. 

SiGNA. — Apply  as   in  use    of    carbolic 
acid. 

For  Stomatitis. 

Alvin. 
R.    Thymolis  (cryst. )   .    .ptm.j 

Glycerini pts.  lOO. 

SiGNA. — To  be  used  as    a    lotion  and 
gargle. 

For  an    Antiseptic    in  Suppurating 

Pulps,  Alveolar  Abscess,  etc. 
R.    Thymolis  (cryst.)  .    .  ptm.l 

Glycerini pts.ij  to  iv. 

SiGNA. — Applied  in   the  same  manner 
as  carbolic  acid. 

Antiseptic  and  Germicide  Mouth-  Wash. 
W.  D.  Miller. 

R.    Thymol grs.iv 

Benzoic  acid    ....  grs.45 

Eucalyptol 33^ 

Alcohol 325 

Oil  of  wintergreen  .    .  gtt.25.    M. 
34 


An  Antiseptic  Gargle. 


R 


Thymol 3j4  grs. 

Benzoic  acid  ....    45  grs. 

Tine,  of  Eucalyptus.  180  grs.  * 

Water Oij.     M. 

SiGNA. — After  cleansing  the  teeth,  use 
as  a  gargle  for  half  a  minute  or  a 
minute. 


R, 


Antiseptic  Fluid. 

VOLXMANN. 

Thymol i  part 


M. 


M. 


Alcohol 10  parts 

Glycerin 20  parts 

Water 100  parts. 

SiGNA. — Apply  as  a  lotion. 

For  Stomatitis. 
David. 

R .    Thymol gr.vij 

Borax gr.xv 

Water o '^^• 

SiGNA. — Use  as  a  tonic  and  antiseptic 
mouth-wash,  by  placing  a  few  drops 
in  a  wine-glass  of  warm  water. 

For  Fetid  Breath  from   Deposits  about 
Tonsils  and  Gtnns. 

David. 

R .     Borate  of  Sodium  .    .   gr.xv 

Alcohol ^ss 

Thymol grvij 

Water Oj.  M. 

SiGNA. — Use  as  a  mouth  wash. 


530  DENTAL   MEDICINE. 


Antiseptic  Mouth  WasA.  For  a  Nerve  Paste. 

Dr.  W.  D.  Miller.  Dr.  S.  H.  McNaughton. 

R.    Thymolis g^-  ij  R-    Thymolis gr.xxiv 

Acidi  benzoic! .  .    .    .    gr.xlvj  Camphorse  .....  gr.xij 

Hydrarg.   bichlor.  .    .   gr.ix  Acidum  arseniosum    .  gr.iij.        M. 

Tinct.  eucalypti  .  .    .  ^  ss  If  much  pain  follows  the  application 

Olei  peppermint  .  .    .   gr.xj  of  the  above,  apply  at    once  without 

Alcoholis S^J^vj-    M.  washing  out  the  cavity  : 

Filter  and  add  sufficient  of  the  solu-       R .    Camphorae gr.  60 

tion  to  a  wine-glass  of  water.  Acidi  tannici  .    .    .    .   gr.30 

SiGNA. — Rinse  with  this  mixture  twice  Alcoholis 5J  ^• 

sufficiently  to  sterilize  mouth. 

Thyinacetin  bears  the  same  relation  to  thymol  as  phenacetine 
to  phenol.  .  It  is  a  white,  crystalline  powder,  slightly  soluble 
in  water.  Excessive  doses  cause  symptoms  of  intoxication. 
Jolly  asserts  that  in  certain  forms  of  headache  it  proves  equal 
to  phenacetine.  It  induces  sleep  in  cases  of  insomnia.  The 
average  dose  is  grs.  viiss. 

TRICHLORACETIC  ACID— ACIDUM   TRICHLORACETICUM. 

Formula. — C2HCI3O2. 

Derivation. — Trichloracetic  acid  is  prepared  by  the  oxidation 
of  hydrate  of  chloral  by  means  of  nitric  acid.  It  consists  of  col- 
orless, rhombic  deliquescent  crystals.  It  belongs  to  a  group  of 
three  acids,  the  other  two  being  the  monochloracetic  and  the 
dichloracetic  acids,  and  the  difference  in  their  composition  is 
due  to  the  proportions  of  chlorine  they  contain.  They  have 
similar  properties. 

Medical  Properties  aiid  Actioji.  —  Trichloracetic  acid  is 
readily  soluble  in  water  and  alcohol,  with  an  agreeable  odor. 
It  coagulates  albumen,  and  its  concentrated  solutions  are  pow- 
erfully caustic.  Diluted  solutions  cause  an  increased  secretion 
of  saliva,  and  destroy  its  power  to  convert  starch  into  sugar ; 
it  also  arrests  the  digestive  action  of  pepsin.  As  an  antiseptic 
it  has  been  employed  in  putrid  and  indolent  wounds,  in  the 
form  of  weak  solutions,  which  are  unirritating,  and  promotes 
healthy  granulations  and  cicatrization ;  it  has  also  been  em- 
ployed externally  in  erysipelas  and  venereal  sores.    Internally, 


TRICHLORACETIC   ACID.  531 

it  has  been  recommended  by  Dr.  Filippowitch  as  a  preventive 
of  cholera,  in  doses  of  gr.  ij  to  iij,  three  or  four  times  daily. 
Externally,  it  is  employed  in  one  or  two  per  cent,  solutions. 
The  common  dose  is  gr.  ij  to  v.  in  very  dilute  solutions,  three 
times  a  day. 

Therapeiitic  Uses. — Trichloracetic  acid  is  stimulant,  refriger- 
ant, antiseptic,  and  a  solvent  of  calculi.  It  is  also  a  power- 
ful caustic  and  escharotic ;  diluted  with  water  to  a  strength  of 
three  per  cent,  it  is  an  efficient  astringent  and  stimulant,  and 
diluted  to  a  strength  of  one  per  cent,  it  is  useful  as  a  refrigerant 
mouth-wash.  It  coagulates  albumen,  and  its  concentrated 
solutions  are  caustic.  Diluted  solutions  cause  an  increased 
secretion  of  saliva,  and  destroy  its  power  to  convert  starch 
into  sugar ;  it  also  arrests  the  digestive  action  of  pepsin.  It  is 
employed  as  an  antiseptic  in  the  treatment  of  putrid  and  in- 
dolent wounds,  in  the  form  of  weak,  unirritating  solutions,  and 
promotes  healthy  granulations  and  cicatrization ;  it  has  also 
been  employed  externally  in  erysipelas  and  on  venereal  sores. 
Externally,  it  is  generally  employed  in  one  or  two  per  cent, 
solutions.  It  destroys  all  forms  of  organic  life  in  such  a  per- 
centage ;  and  in  five  per  cent,  solution  it  arrests  the  growth  of 
bacteria  and  other  forms  of  micro-organisms.  Internally,  it 
has  been  administered  in  cholera,  gastric  catarrh,  etc.,  in  doses 
of  [grain  ij  to  iij  :  for  summer  complaint  of  children,  the  dose 
is  J^  to  I  grain,  3  times  daily. 

Dental  Uses. — Trichloracetic  acid  is  employed  in  dental  prac- 
tice as  an  escharotic  in  the  treatment  of  pyorrhoea  alveo- 
laris,  on  account  of  its  destructive  effect  on  pus  secreting  sur- 
faces of  the  alveoli  of  teeth,  for  which  purpose  a  ten  per  cent, 
solution  is  applied.  It  is  also  employed  for  the  removal  of 
vascular  tumors  of  the  pulp,  and  hypertrophy  of  the  margins 
of  the  gums,  and  epulis.  Dr.  Kirk  speaks  of  using  this  acid  in 
the  strong  solution  of  about  ninety  per  cent,  for  the  removal 
of  such  growths.  Trichloracetic  acid  has  also  a  solvent  effect 
on  calculi  upon  the  roots  of  teeth,  a  ten  per  cent,  solution  in 
water  being  recommended,  and  has  also  been  employed  on 
the  overhanging  and  resistant  gum  of  third  molars.     A  one 


532  DENTAL  MEDICINE. 


per  cent,  solution  has  been  successfully  employed  as  a  mouth- 
wash, for  its  astringent  and  stimulating  action  in  inflamma- 
tions and  ulcerations.  It  is  also  used  in  combination  with 
pyrozone  in  the  treatment  of  alveolar  pyorrhoea,  and  in  such 
a  solution,  as  well  as  alone,  its  effects  have  been  remarkably 
satisfactory.  Trichloracetic  acid  may  be  combined  with  any 
suitable  alkaline  solution,  such  as  soda  or  magnesia,  when  it 
is  desirable  to  limit  its  action.  It  has  a  peculiar  power  to 
soften  and  remove  sanguinary  deposits,  and  it  acts  without 
injury  to  the  teeth  or  soft  tissues. 

Diluted  with  water  to  a  three  per  cent,  solution  it  is  an 
excellent  local  astringent  and  stimulant.  Dr.  Harlan  recom- 
mends it  for  removing  the  overlying  gum  for  third  molars,  as 
it  destroys  the  tissue  without  hemorrhage  or  subsequent  sore- 
ness. Trichloracetic  acid  is  also  employed  to  gain  access  to 
roots  of  abscessed  teeth  through  a  fistulous  opening,  one  crystal 
followed  by  more  being  placed  in  the  fistula ;  it  is  also  used 
for  removing  hypetrophied  gums,  and  gum  polypi. 

TRICHLORPHENOL. 

Formula. — CgHgC^OH). 

Derivation. — Trichlorphenol  is  obtained  by  combining  chlor- 
inated lime  and  carbolic  acid.  One  pound  of  a  solution  of  car- 
bolic acid  (four  per  cent,  solution)  is  mixed  with  five  pounds 
of  solution  of  chlorinated  lime  and  then  filtered.  If  too  strong, 
it  can  be  diluted  with  boiling  water  to  the  required  strength. 

Medical  Properties  and  Therapeutic  Uses. — Trichlorphenol 
has,  according  to  Diannin,  an  antiseptic  power  twenty-five  times 
greater  than  carbolic  acid,  and  also  exceeding  that  of  thymol, 
salicylic  acid,  and  chlorinated  lime.  A  one  per  cent,  solution 
has  been  employed  in  the  treatment  of  ulcers.  It  has  also  been 
employed  in  the  form  of  solution  in  erysipelas,  and  as  an  injec- 
tion in  leucorrhoea  and  dysentery. 

TRICRESOLE.— TRIKRESOLE. 

Tricresol  is  a  mixture  of  orthocresole,  metacresole,  and  para- 
cresole,  in   the  form   of  a  liquid  which  is  soluble  in  water  in 


TROPACOCAINE.  533 


proportion  of  from  two  to  two  and  a-half  per  cent.  Prof 
Charteris  finds  it  to  be  three  times  as  strong  as  pure  carbolic 
acid  as  a  germicide,  and  only  a  third  as  poisonous.  He  con- 
siders its  advantages  for  surgical  purposes  to  be  very  pro- 
nounced ;  and  suggests  that  in  all  probability  some  combina- 
tion of  it  with  an  alkaline  base  will  in  the  future  be  prepared 
which  may  with  safety  and  profit  be  administered  internally 
in  specific  infectious  diseases.  Trikresole  contains  the  cresols 
in  a  pure  condition,  and  is  practically  free  from  phenol.  It  is 
a  clear,  colorless  liquid,  with  a  pleasant  odor  resembling  crea- 
sote,  and  is  soluble  in  cold  water  to  the  extent  of  2.2  to  2.5 
per  cent.  Frankel  and  Gruber  found  that  a  i  per  cent,  aqueous 
solution  is  equal  to  a  3  per  cent,  solution  of  carbolic  acid,  and 
consequently,  trikresole  possesses  the  threefold  disinfectant  and 
antiseptic  value  of  carbolic  acid.  The  solutions  remain  clear, 
and  do  not  corrode  instruments.  It  is  also  free  from  the  pyri- 
dine odor  of  other  cresol  preparations.  A  one  per  cent,  solution 
will  destroy  pus-germs  in  thirty  seconds. 

The  presence  of  albumen  does  not  interfere  with  its  action. 

TROPACOCAINE— BENZOYL-PSEUDO-TROPEIN. 

Derivation. — Tropacocaine  is  an  alkaloid  obtained  from  the 
leaves  of  a  plant  of  the  coca  family,  indigenous  to  Java,  and  has 
been  isolated  by  Giesel.  The  hydrochlorate  of  tropacocaine 
was  prepared  by  Lieberman,  as  the  base  of  the  product  he 
obtained  synthetically,  which  was  not  very  soluble  in  water. 
Unlike  cocaine  solution,  which  deteriorates  in  a  few  days,  the 
solution  of  the  salt  tropacocaine  can  be  kept  for  several 
months  without  decomposition.  Tropacocaine,  by  its  chemical 
composition,  belongs  to  the  atropine  group. 

Therapciitic  Action. — Tropacocaine  is  a  local  anaesthetic,  and, 
as  indicated  by  a  series  of  experiments  made  by  Chadbourne, 
is  about  half  as  toxic  as  cocaine,  and  possesses  the  same  local 
anaesthetic  properties  without  the  accidents  of  the  latter  agent. 

No  symptoms  indicating  the  physiological  action  of  tropa- 
cocaine followed  its  administration  internally  in  the  case  of  a 
dose  varying  from  one-third  to  three-quarters  of  a  grain ;  and 


534  DENTAL  MEDICINE. 


a  submucous  injection  of  nearly  one-half  grain  in  ten  drops  of 
water  in  many  nervous  and  frightened  persons,  produced  only 
a  slight  increase  in  the  number  of  radial  pulsations,  without 
any  changes  in  the  arterial  pressure.  No  bad  symptoms  appar- 
ently followed  the  hypodermic  injection  of  three-quarters  to 
one  grain  of  tropacocaine  even  in  nervous,  anaemic  and  tuber- 
culous patients,  according  to  Pinet  and  Vian,  although  they 
observed,  contrary  to  what  occurs  in  cocaine,  an  increased 
activity  in  the  peripheral  circulation,  the  face  exhibiting  a 
characteristic  rosy  hue,  and  the  extremities  becoming  warm. 
Their  conclusion  was  that  tropacocaine  hydrochlorate  possesses 
local  anaesthetic  properties  analogous  to  cocaine.  It  is  also 
claimed  that  the  more  concentrated  the  solution  of  this  drug, 
the  more  rapid  is  its  action.  Its  effect  upon  the  nervous  sys- 
tem, as  well  as  upon  the  respiration,  is  directly  opposite  to 
what  occurs  in  the  intoxication  by  cocaine,  as  an  equal  part  of 
cocaine  has  produced  dangerous  symptoms,  and,  on  the  con- 
trary, neither  respiration  nor  the  nervous  system  appears  to  be 
influenced  by  doses  of  three-quarters  of  a  grain  of  tropacocaine. 
And  although  its  use  may  not  be  without  danger,  yet  it  is  un- 
doubtedly much  less  toxic  than  cocaine.  But  from  the  fact 
that  its  toxic  action  on  the  heart  is  very  rapid  when  such  does 
occur  (although  it  lasts  but  ten  minutes,  while  that  from  cocaine 
may  last  for  hours),  yet  the  use  of  tropacocaine  requires  cau- 
tion. Dr.  Hugenschmidt  claims  that  the  advantages  of  tropa- 
cocaine over  cocaine  are  : 

1.  Used  in  equal  dose  sufficient  to  produce  local  anaesthe- 
sia, the  new  drug  is  much  less  toxic  than  cocaine,  and  has  a 
very  slight  action  on  the  vital  functions  of  the  economy. 

2.  It  produces  a  local  anaesthesia  more  rapid  and  more  pro- 
nounced than  cocaine,  and  of  at  least  as  great  a  duration. 

3.  The  solution  of  the  salt  being  an  antiseptic,  as  was  point- 
ed out  by  Chadbourne,  can  be  kept  for  several  months  without 
deterioration,  while,  after  a  few  days,  a  cocaine  solution  is 
worthless  for  injections. 

Dental  Uses. — Tropacocaine  is  employed  in  dental  practice 
as  a  local  anaesthetic  for  the  extraction  of  teeth,  for  the  perfora- 


URETHAN.  535 


tion  of  the  alveolus,  removing  sequestrum,  sensitive  dentine, 
opening  of  abscesses,  etc.  Dr.  Hugenschmidt  regards  two- 
thirds  of  one  grain  in  fifteen  drops  of  water  as  sufficient  in 
ordinary  cases.  For  difficult  extractions,  four-fifths  of  one 
grain,  he  asserts,  will  produce  complete  anaesthesia.  The 
injections  are  made  as  with  cocaine,  but  not  suddenly,  as  at 
least  one  minute  should  be  employed  in  injecting  the  dose, 
which,  according  to  Dr.  Hugenschmidt,  is  ten  drops  of  the 
follovving  solution:  Tropacocaine  hydrochlorate,  2  grains; 
distilled  water,  50  drops.  M.  S. — Gtt.  x  for  one  local  anaes- 
thesia. The  tooth  or  root  to  be  extracted,  or  region  to  be 
operated  on,  is  surrounded  by  a  series  of  injections  of  one  or 
two   drops  of  the  above  solution   until  ten  drops   have  been 

injected. 

URETHAN— URETHANE. 

Derivation, — Urethan  is  a  combination  of  carbonic  acid  and 
ethylic  ether.  It  occurs  in  white  crystals,  without  odor,  taste- 
less and  insoluble  in  water. 

Medical  Properties  and  Therapeutic  Uses. — Urethan  is  a  hyp- 
notic which  may  be  employed  to  cause  quiet  and  sleep  when 
the  conditions  are  favorable  to  its  action.  It  is  similar  to 
paraldehyde  and  has  no  irritating  effect  upon  the  stomach,  nor 
does  it  impair  digestion.  Although  insoluble  in  water,  the 
fluids  of  the  stomach  dissolve  it  readily,  and  it  promptly  diffuses 
into  the  blood.  The  first  effect  of  its  action  is  stimulating, 
which  is  of  brief  duration,  then  a  diminution  of  action,  slowing 
of  circulation  and  respiration,  decline  of  temperature  and  weak- 
ening of  the  reflexes  which  finally  disappear,  then  drowsiness 
and  tranquil  sleep,  and,  if  the  quantity  given  be  toxic,  coma 
and  insensibility.  Fifteen  and  one-half  grains  are  held  suffi- 
cient to  cause  sleep.  It  is  not  an  analgesic,  hence  pain  will 
prevent  its  hypnotic  action.  Unpleasant  after-effects  do  not 
occur,  except  when  stomachal  troubles  are  present,  and  it  is 
seldom  that  there  is  lieadache,  nausea,  or  vertigo.  Sleep  is 
produced  in  fifteen  minutes  to  an  hour,  and  continues  from  six 
to  eight  hours.    It  has  been  employed  with  benefit  in  epilepsy, 


536  DENTAL  MEDICINE. 


chorea,  spasms,  cramp,  delirium  tremens,  tetanus,  etc.    Its  action 

upon  digestion  is  as  follows  : 

a.  Strong  solutions — that  is,  0.5  gramme,  0.25  gramme, 
0.175  gramme — delayed  digestion;  that  the  stronger  the  solu- 
tion the  greater  was  the  delay. 

b.  Weak  solutions — that  is,  1,2  and  3  milligrammes — neither 
delayed  nor  accelerated  digestion. 

c.  Neither  strong  nor  weak  solutions  retarded  decomposi- 
tion. 

VALERIANA— VALERIAN. 

Source. — Rhizoma  and  rootlets  of  Valeriana  officinalis.  Va- 
lerian contains  a  volatile  oil,  and  from  it  several  prepara- 
tions are  obtained,  among  them  valeric  acid,  HCgHgO,,  to 
which  the  virtues  of  the  agent  are  principally  due.  This  acid 
is  now  prepared  from  fusel  oil,  and  is  not  the  same  as  that 
from  valerian  although  it  is  largely  used  as  a  substitute. 

Valerianates  are  made  from  the  acid  prepared  from  fusel 
oil,  but  are  not  as  good  as  the  preparations  from  valerian. 
The  official  valerianates  are  Animonii  valerianas  (NH4)C5H902; 
dose,  gr.  ij  to  x.  Ferri  valerianas,  Fe  (C5H902)6;  dose,  gr.  j  to 
iij.  Quininse  valerianas;  dose,  gr.  j  to  iij.  Zinci  valerianas 
(QH9a)H20;  dose,  gr.  >^  to  ij. 

Medical  Properties  and  Uses. — Valerian  and  its  preparations 
have  a  peculiar,  disagreeable  odor  and  a  hot,  pungent  taste, 
with  a  sensation  of  warmth  at  the  epigastrium,  being  a  gentle 
stimulant  and  antispasmodic.  In  moderate  doses  the  action 
of  the  heart  is  increased,  with  a  rise  of  temperature  and  dia- 
phoresis. Large  doses  cause  nausea,  hiccough,  eructations, 
vomiting  and  diarrhoea.  Small  doses  have  no  apparent  phy- 
siological effects.  It  antagonizes  strychnine.  Valerianic  acid 
is  apparent  in  the  breath,  perspiration  and  urine.  Valerian  is 
frequently  employed  in  hysteria  and  general  nervousness,  as 
are  also  the  valerianates;  also  in  flatulence,  whooping-cough, 
neuroses  of  the  respiratory  organs,  epilepsy,  chorea,  paralysis 
agitans,  diabetes,  etc.  Valerianate  of  ammonia  is  used  in  ner- 
vous headache  and  in  dental  and  other  neuralgias.  (See  Va- 
lerianate of  Ammonia). 


VASELINE.  537 


Dose. — Of  Abstractum  Valerian(z — Abstract  of  valerian,  gr. 
V  to  3j.  Of  Extractum  ValeriancE  Fliiidiihi — Fluid  extract  of 
valerian,  5ss  to  Sss.  Of  Tinctiira  ValeriancE — Tincture  of  va- 
lerian, 5ss  to  5ij-     Of  Oleum  Valerianoe — Oil  of  valerian,  TTlij 

to  miv. 

VASELIN— VASELINE. 

PETROLEUM  OINTMENT— PETROLATUM.  COSMOLINE. 

Derivation. — Vaseline  is  obtained  from  crude  petroleum,  in 
the  form  of  a  petroleum  jelly.  In  the  distillation  of  crude  petro- 
leum there  remains  in  the  apparatus,  after  the  separation  of  the 
light  oils,  a  semi-liquid  tar,  which  constitutes  crude  vaseline, 
which,  in  such  a  state,  has  a  disagreeable  odor  like  petroleum, 
of  a  strong  taste  and  black  color.  This  compound  is  heated 
in  the  open  air,  and  decolorized  by  animal  charcoal,  the  pro- 
duct being  the  petroleum  jelly  known  as  vaseline,  which  is 
a  mixture  of  several  hydrocarbons. 

When  pure,  vaseline  is  white,  inodorous  and  insipid,  and 
of  the  consistence  of  jelly,  or  very  unctuous  fat.  It  melts  at 
35°  C,  boils  at  150°  C,  and  distills  at  200°  C,  and  burns 
without  residue.  Exposed  for  a  considerable  time  to  light,  it 
acquires  a  slight  odor  of  petroleum.  It  is  insoluble  in  water, 
sparingly  soluble  in  alcohol,  and  very  soluble  in  warm  ether, 
chloroform,  fats,  volatile  oils,  and  sulphide  of  carbon.  It  sen- 
sibly dissolves  iodine,  bromine,  sulphur,  phosphorus,  carbolic 
acid,  benzoic  acid,  atropine  and  strychnine: 

Medical  Properties  and  Action. — By  its  composition,  vaseline 
is  not  capable  of  becoming  rancid,  nor  of  being  saponified  ; 
hence  it  is  a  very  useful  agent  or  excipient  for  caustic  alkalies, 
oxides,  metallic  salts,  and  even  acids  in  the  cold  without  action 
by  them,  and  without  modifying  their  therapeutic  properties. 
Incorporated  in  ointments,  a  certain  quantity  of  vaseline  will 
preserve  them  and  obviate  rancidity,  being  preferable  to  lard, 
butter,  glycerine  and  glyceroles.  The  addition  of  paraffin  will 
give  it  any  consistency  desired. 

Therapeutic  Uses. — Vaseline  is  used  externally  as  a  dressing 
for  wounds,  cuts,  bruises,  sprains,  piles,  rheumatism,  skin  dis- 
eases, eczema,  inflamed  surfaces,  diseases  of  the  eye,  etc.,  etc. 


538  DENTAL   MEDICINE. 


Combined  with  carbolic  acid,  it  forms  a  very  useful  ointment 
for  affections  of  the  skin,  putrescent  pulps  of  teeth,  etc.,  etc., 
under  the  name  of  carbolized  cosnioline. 

Dental  Uses. — Vaseline  is  an  efficacious  application  to  in- 
flamed and  excoriated  surfaces  of  the  gums  and  mucous  mem- 
brane of  the  mouth ;  also  as  a  dressing  introduced  into  the 
canals  of  teeth  affected  with  periodontitis,  and  as  an  emollient 
application  after  the  devitalization  and  removal  of  dental  pulps. 
Carbolated  cosmoline  on  cotton  has  been  employed  for  filling 
root  canals,  but  the  results  have  not  in  all  cases  been  satisfac- 
tory. 

In  the  form  of  Vaseline  Camphor  Ice,  it  is  a  pleasant  and 
efficacious  application  to  chapped  lips  and  hands,  being  bland 
and  non-irritating  in  its  action. 

An  ointment  made  by  dissolving  and  incorporating  thor- 
oughly by  the  aid  of  heat,  equal  parts  of  vaseline  and  lead 
plaster,  to  which  a  little  bergamot  may  be  added  for  perfume, 
is  very  serviceable  for  the  treatment  of  excoriated  surfaces, 
and  dry  desquamating  surfaces  of  certain  skin  diseases,  and 
especially  the  form  of  skin  affection  which  may  result  from 
the  constant  use  of  scented  soaps  on  the  hands. 

DENTAL    FORMULA. 

Local  AncEsthetic. 
Dr.  Poinsot. 
B; .         Oleo-naphthine  (liquid  vaseline), 

Arachis  oil    ...    , aa  50  centigrammes. 

Pure   cocaine 5  centigrammes. 

M. — Dissolve  the  cocaine  in  a  hot  water  bath  and  wash  gum 
where  the  injection  is  to  be  made  with  absolute  alcohol.  S. — Make 
a  number  of  injections  around  tooth  slowly,  and  wait  8  minutes. 

Vaselone. — Vaselone  is  a  substitute  for  vaseline,  and  consists 
of  a  solution  of  stearone  and  margarone  in  neutral  mineral 
oil.  Stearone  is  prepared  by  distilling  stearin  with  lime. 
Margarone  is  prepared  in  a  similar  way,  from  beef  suet. 
Vaselone  consists  of  1 5  parts  of  margarone  and  5  of  stearone, 
in  TOO  of  thoroughly  purified  and  odorless  mineral  oil.  The 
fatty  product  obtained,  after   cooling,  resembles  vaseline,  but 


VERATRINE.  539 


is  not  as  transparent.     It  is  white,  odorless,  neutral,  and  not 
affected  by  acids  and  chemical  reagents. 

VERATRINA— VERATRINE. 

Source. — Veratrine  is  an  alkaloid,  or  a  mixture  of  alkaloids, 
obtained  from  the  seeds  of  Asagrcea  officinalis,  of  the  natural 
order  Mclantliacece.  It  is  in  the  form  of  a  white,  or  grayish- 
white  amorphous  powder,  of  an  acrid  taste,  imparting  a  sensa- 
tion of  tingling  and  numbness  to  the  tongue,  and  causing  con- 
striction of  the  fauces  and  violent  sneezing.  It  is  but  slightly 
soluble  in  cold  or  hot  water,  to  which  it  imparts  an  acrid  taste 
and  a  somewhat  alkaline  reaction. 

It  is  soluble  in  three  parts  of  alcohol  at  59°  F.,  and  very 
soluble  in  boiling  alcohol ;  also  soluble  in  6  parts  of  ether,  in 
2  parts  of  chloroform,  and  in  96  parts  of  glycerin ;  it  melts 
when  heated. 

Veratrine  Ointment — Ungiientimi  VeratrincB — is  composed 
of  veratrine,  4  parts ;  alcohol,  6  parts  ;  benzoinated  lard,  96 
parts.  The  veratrine  is  rubbed  with  the  alcohol  in  a  warm 
mortar  until  dissolved,  and  the  benzoinated  lard  gradually 
added  and  thoroughly  mixed. 

Therapeutic  Uses. — Veratrine  is  only  used  externally  in  neu- 
ralgia, myalgia,  headache,  rheumatism,  paralysis,  etc.,  in  the 
form  of  the  ointment,  or  dissolved  in  alcohol. 

Dental  Uses. — Veratrine,  in  the  form  of  the  ointment,  is  used 
for  facial  and  other  forms  of  neuralgia,  a  small  quantity  being 
rubbed  over  the  seat  of  pain.  It  is  also  used  as  an  obtundent 
of  sensitive  dentine. 

DENTAL     FORMULA. 
For  Sensitive  Dentifte.  For  Facial  Netiralgia. 

BOGUE.  Garretson. 

R .    Veratrinse gr.  iv  R .    Veratrinee gr.iv 

Acidum  tannicum  .    .    .    gr.j  Aconitinse gr.ij 

Alcoholis gtt.xx  Olei  tiglii gtt.ij 

Glycerini i"^]  Olei  olivai ^ij.     M. 

Acidi  carbolici  .    .    .    .  ^ij.      M.  Signa. — Rub  over  affected  part  thrice 
SiGNA. — Dry  the  tooth  thoroughly  and  daily, 

apply  to  sensitive  surface. 


540  DENTAL   MEDICINE. 


VERATRUM  VIRIDE— AMERICAN  HELLEBORE. 
POKE  ROOT. 

Source. — Veratrum  Viride,  of  the  natural  order  Melanthacece, 
the  officinal  portion  of  which  is  the  root,  is  indigenous  to  the 
swampy  portions  of  the  United  States,  and  is  prepared  in  the 
form  of  slices  or  fragments,  of  a  dark  or  blackish-gray  color 
externally,  and  of  a  grayish-white  color  internally.  Its  odor 
is  peculiar,  especially  when  it  is  moistened,  and  its  taste  is 
bitter  and  acrid.  It  is  inodorous,  but  in  the  form  of  powder 
is  sternutatory.  It  is  similar  in  chemical  composition  to  vera- 
trum album — white  hellebore  and  veratrum  sabadillae.  Like 
veratrum  album,  it  contains  a  quantity  of  soft  resin,  and  two 
alkaloids — -j'ervia  and  vej^atroidia. 

Medical  Properties  and  Action. — Veratrum  v^iride  is  acrid  and 
sedative,  causing  redness  and  heat  when  applied  to  the  skin, 
and  has  a  violent  sternutatory  effect  on  the  Schneiderian  mem- 
brane. Small  doses  stimulate  the  secretions  and  depress  the 
pulse.  Although  a  prompt  emetic,  its  operation  is  attended 
with  intense  nausea  and  depression,  and  violent,  persistent 
vomiting.  Large  doses  occasion  great  depression,  with  a  weak 
action  of  the  heart  and  pulse,  vomiting,  retching,  cold  sur- 
face of  body,  a  cold  perspiration,  faintness,  dimness  of  sight, 
dilatation  of  the  pupils,  great  muscular  weakness,  slow  res- 
piration, and  sometimes  coma,  insensibility  and  stertorous 
breathing,  but  notwithstanding  such  symptoms,  fatal  results 
are  rare.  The  antidotes  are  free  stimulants.  The  tincture — 
Tinctura  Yeratri  Viridis — is  the  best  preparation  for  internal 
administration. 

Tlierapentic  Uses. — Veratrum  viride  is  not  employed  for  its 
emetic  effect,  on  account  of  its  violent  action.  Internally  it  is 
administered  in  diseases  of  the  heart,  active  hemorrhage  in 
the  plethoric,  to  reduce  the  temperature  and  pulse  in  "  typhoid 
and  other  fevers,"  in  acute  mania  and  delirium,  in  puerperal 
convulsions,  neuralgia,  neuralgic  headache,  etc.  Externally 
it  is  employed  for  neuralgia,  myalgia,  headache,  rheumatism, 
paralysis,  etc. 


PRICKLY   ASH.  541 


Dose, — Of  the  tincture  of  veratrum  viride,  THi  to  TTLv;  of 
the  fluid  extract  of  veratrum  viride — Extractum  Veratri  Viridis 
Fliddinn,  IfliLij  to  1Uv;  veratrina,  gr.  -^V  to  gr.  tV- 

Dental  Uses. — In  dental  practice,  the  tincture  of  veratrum 
viride  has  been  employed  internally  for  neuralgia  of  the  fifth 
nerve  ;  also  in  periodontitis,  as  a  sedative  ;  also  in  severe  hemor- 
rhage from  the  extraction  of  teeth,  to  depress  the  heart's 
action. 

DENTAL   FORMULA. 

For  Facial  Neuralgia. 

Da  Costa. 

R  .        Veratriffi gr.xv 

Aconitise gr.  ij 

Glycerinse f^ij 

Cerati  adipis f^^'j-  M. 

SiGNA. — To  be  rubbed  over  painful  part,  care  being  taken  to  see  that 
there  is  no  abrasion  of  the  skin. 

XANTHOXYLUM— PRICKLY  ASH. 

Source. — Xanthoxylum  is  a  shrub  growing  in  the  northern, 
middle  and  western  States  of  North  America.  The  bark  is 
the  officinal  portion,  and  is  obtained  in  the  form  of  pieces, 
more  or  less  quilled,  of  one  or  two  lines  in  thickness  and  of  a 
whitish  color,  with  an  ash-colored  epidermis.  It  is  quite  ino- 
dorous and  has  a  taste  at  first  sweetish  and  slightly  aromatic 
and  afterwards  bitter  and  acrid. 

Medical  Properties  and  Action. — Xanthoxylum  is  aromatic, 
stimulant  and  sialagogue,  and  when  swallowed  occasions  a 
sense  of  heat  in  the  stomach,  more  or  less  general  arterial 
excitement,  and  a  tendency  to  diaphoresis. 

Therapeutic  Uses. — Xanthoxylum  has  been  administered  with 
considerable  benefit  in  the  chronic  form  of  rheumatism. 

Dose. — Of  powdered  xanthoxylum,  gr.  x  to  5ss,  three  or 
four  times  a  day. 

Dental  Uses. — Xanthoxylum,  in  the  form  of  the  powder,  has 
been  applied  with  success  to  an  aching  pulp  for  the  relief  of 
odontalgia,  and  a  decoction  of  the  bark  is  employed  as  a  wash 
for  foul  ulcers;  in  the  form  of  a  tincture  it  is  efficacious  in  re- 


542  DENTAL   MEDICINE. 


lieving  the  soreness  which  remains  after  the  extirpation  of 
the  dental  pulp ;  it  is  applied  on  floss  silk  or  cotton.  In  the 
Southern  States  the  Angelica  Tree  —  Aralia  Spinosa,  some- 
times called  "  Toothache  Tree,"  is  often  called  prickly-ash, 
but  it  differs  from  xanthoxylum,  although  its  tincture  answers 
for  the  relief  of  odontalgia. 

ZINCI  CHLORIDUM— CHLORIDE  OF  ZINC. 

Formula. — ZnClg- 

Derivation. — Chloride  of  Zinc  is  obtained  by  the  action  of 
hydrochloric  acid  on  granulated  zinc,  the  solution  thus  made 
being  purified  by  a  solution  of  chlorine  and  carbonate  of  zinc, 
when  it  is  evaporated  till  it  assumes  a  solid  form.  It  is  in 
the  form  of  a  white  deliquescent  salt,  freely  soluble  in  water, 
alcohol  and  ether,  as  soft  as  wax,  and  capable  of  being  melted 
and  sublimed  by  heat.  As  it  rapidly  deliquesces  when  ex- 
posed to  the  air,  it  should  be  kept  in  glass-stoppered  bottles. 
It  has  a  styptic,  metallic  taste,  which  is  very  disagreeable. 

Medical  Properties  and  Action. — Chloride  of  zinc  is  the  most 
active  of  the  zinc  preparations,  being  a  powerful  and  penetrat- 
ing escharotic.  Its  local  action  as  a  caustic  depends  upon  its 
affinity  for  albumen  and  gelatin,  and  when  in  contact  with  living 
parts  it  destroys  their  vitality,  and  uniting  with  the  albuminous 
and  gelatinous  matters  present,  forms  an  eschar.  It  is  also  a 
useful  deodorizer  and  disinfectant,  and  largely  diluted  has  been 
employed  as  a  nervine  tonic ;  but  as  the  milder  preparations 
of  zinc  answer  the  same  purpose,  it  is  rarely  employed  inter- 
nally. On  account  of  the  great  affinity  for  water  and  its  power 
of  combination  with  albumen,  chloride  of  zinc  penetrates  and 
spreads  deeply,  and  produces  an  eschar  which  is  white,  thick 
and  hard.  When  applied  to  malignant  and  indolent  ulcers,  it 
promotes  healthy  granulations,  and  also  when  topically  applied 
it  not  only  destroys  the  diseased  structure,  but  excites  a  new 
and  healthy  action  in  the  surrounding  parts.  When  employed 
as  a  caustic,  it  does  not  give  rise  to  constitutional  disorder  from 
absorption,  an  effect  which  is  sometimes  caused  by  arsenical 
preparations.     In  over-doses  it  causes  a  burning  pain  in  the 


CHLORIDE   OF   ZINC.  543 


throat  and  stomach,  nausea,  vomiting,  cold  sweats,  decrease  of 
pulse,  cramps  of  the  limbs,  etc.,  being  a  powerful  irritant  poison. 
The  antidotes  in  poisoning  by  zinc  salts  are  albumen,  carbonate 
of  soda,  magnesia  and  soap. 

Therapeutic  Uses. — Chloride  of  zinc  has  been  employed  inter- 
nally in  chorea,  epilepsy,  neuralgia,  scrofula,  and  combined  with 
hydrocyanic  acid,  in  facial  neuralgia.  Externally  it  is  applied  to 
malignant  growths,  gonorrhoea,  indolent  ulcers,  etc.  A  solution 
of  the  chloride  of  zinc  is  used  as  an  antiseptic  and  disinfectant. 

Liquor  Zinci  Chloridi — Solution  of  Chloride  of  Zinc, 
known  as  "  Burnett's  Disinfecting  Fluid,"  is  composed  of 
chloride  of  zinc,  gr.  cc,  water,  oj. 

Dose. — Of  Chloride  of  zinc,  gr.  ss.  or  gr.  j,  or  gr.  ij,  largely 
diluted. 

Dental  Uses. — Chloride  of  zinc  is  a  valuable  agent  in  dental 
practice,  being  employed  as  an  external  application  to  sensitive 
dentine.  As  an  obtunding  agent,  a  drop  of  the  deliquescent 
chloride  is  placed  in  contact  with  the  sensitive  dentinal  surface 
(which  has  previously  been  dried  and  is  protected  from  all 
moisture),  and  allowed  to  remain  from  two  to  four  minutes. 
Considerable  pain  follows  the  application  of  the  chloride,  which 
is  of  a  steady  continuous  character,  without  the  throbbing 
nature  which  characterizes  the  pain  of  an  irritated  dental  pulp. 
Its  painful  action  may  be  modified  by  bathing  the  sensitive 
surface,  prior  to  the  application  of  the  chloride,  with  chloro- 
form, tincture  of  aconite  or  atropine  solution,  or  a  combination 
made.  When  the  pain  has  subsided,  the  excavation  of  the 
cavity  can  be  proceeded  with  until  the  layer  of  dentine  affected 
by  the  chloride  has  been  removed,  when  another  application 
may  be  necessary.  As  it  is  not  absorbed  by  the  dentine  to 
any  great  degree,  its  action  being  superficial,  it  is  not  so 
dangerous  an  agent  as  is  arsenious  acid  when  employed  for 
the  same  purpose. 

In  no  case  should  the  chloride  of  zinc  be  used  as  an  obtunding 
agent,  when  there  is  danger  of  irritating  the  pulp  of  the  tooth. 

Chloride  of  zinc  is  also  employed  to  arrest  superficial  hemor- 
rhage from  a  wound  of  the  gum  during  the  filling  of  teeth ; 


544  DENTAL   MEDICINE. 

it  will  also  temporarily  arrest  the  secretion  of  mucus  from  the 
surface  of  the  mucous  membrane  of  the  mouth.  When 
applied  to  a  cut  surface,  diluted,  it  induces  union  by  first  inten- 
tion, by  its  effect  upon  the  glutinous  matter. 

It  has  also  been  successfully  employed  as  an  injection  for 
chronic  alveolar  abscesses,  and  in  the  treatment  of  ulceration 
of  the  gums  attended  with  recession  of  gum  and  absorption  of 
process  from  the  necks  of  teeth  ;  also  as  an  injection  in  disease 
of  the  antrum.  It  has  been  claimed  that  its  application  in  a 
diluted  form  will  promote  the  formation  of  secondary  dentine 
over  a  nearly  exposed  pulp,  but  its  escharotic  action  must 
be  considered  in  using  the  agent  for  such  a  purpose.  When 
applied  to  the  sulcus  which  often  forms  during  ulceration  and 
recession  of  the  gum  from  the  neck  of  a  tooth,  the  application 
can  be  safely  and  conveniently  made  by  means  of  a  camel's- 
hair  brush,  or  by  a  piece  of  orange  wood  so  shaped  as  to 
permit  of  its  being  introduced  to  the  bottom  of  such  a  sulcus. 
Chloride  of  zinc  is  also  employed  as  a  stimulating  astringent 
in  alveolar  pyorrhoea  in  the  form  of  a  solution  of  five  to  ten 
grains  to  the  ounce  of  water.  Chloride  of  zinc  in  a  properly 
diluted  form  is  an  efficient  disinfectant,  and  has  been  employed 
for  such  a  purpose  in  gangrenous  conditions  of  the  mouth. 

Chloride  of  zinc  is  one  of  the  ingredients  of  the  temporary 
filling  material  composed  of  the  chloride  of  zinc  in  solution 
and  the  oxide  of  zinc,  which  has  been  employed  to  cap  the 
exposed  pulps  of  teeth.  But  owing  to  the  escharotic  action 
of  the  chloride  this  method  has  not  been  uniformly  successful. 
The  zinc  preparations,  however,  answer  good  purposes  as  tem- 
porary filling  materials,  especially  in  sensitive  cavities  where 
the  presence  of  metallic  fillings  would  not  be  tolerated.  (See 
Oxide  of  Zinc.) 

DENTAL    FORMULA. 

For  Injia77ied  Gw7is  and  AIucous  Metnbrane. 

Dr.  W.  S.  Elliott. 

R.        Zinci    chloridum grs.x 

Acidi  carbolici gtts.xx 

Glycerini 

Aqua aa  ^ss.  M. 


/ 

IODIDE   OF   ZINC.  545 


ZINCI  lODIDUM— IODIDE  OF  ZINC. 

Forunda. — Znlg. 

Derivation. —  Iodide  of  zinc  is  obtained  by  digesting  an 
excess  of  zinc  with  iodine  diffused  in  water.  It  is  in  the  form 
of  fine,  white,  dehquescent  needles,  very  soluble  in  water,  and 
of  a  metaUic,  styptic  taste,  resembling  that  of  sulphate  of  zinc, 
and  is  very  liable  to  spontaneous  combustion. 

Medical  Properties  and  Action. — Iodide  of  zinc  is  tonic, 
astringent  and  antispasmodic. 

Therapeutic  Uses. — Iodide  of  zinc  has  been  favorably  em- 
ployed in  chorea,  cachexia,  scrofula  and  hysteria.  It  has  been 
used  for  strumous  inflammations  and  enlargements,  both  ex- 
ternally and  internally.  Externally  it  is  an  efficient  local 
stimulant  and  escharotic,  and  is  considered  to  be  equal,  if  not 
superior,  to  chloride  of  zinc.  In  enlarged  tonsils  it  has  been 
advantageously  employed  in  a  solution  of  lO  to  30  grains  to 
the  ounce  of  water.  In  the  form  of  an  ointment  composed  of 
a  drachm  of  the  iodide  to  the  ounce  of  lard,  it  has  been  used 
in  the  treatment  of  tumors. 

Dose. — Of  iodide  of  zinc,  gr.  j,  gradually  increased  to  gr.  vj, 
given  in  the  form  of  syrup. 

Dental  Uses. — Iodide  of  zinc  is  a  valuable  local  application 
in  alveolar  pyorrhoea,  tumors  of  the  mouth,  enlargement  of 
the  tonsils,  etc.  In  alveolar  pyorrhcea  it  is  used  in  connec- 
tion with  peroxide  of  hydrogen,  which  see. 

DENTAL   FORMULif;. 

For  Alveolar  Pyorrhoea.  For  Alveolar  Fyorrkxa. 

A.  W.  Harlan.  A.  W.  Harlan. 

)^  .    Zinci  iodi gr.x 

Aquae TTLxc.       M. 

Signa. — Inject  with  a  s}Tinge  if  the 
pockets  are  shallow  without  much 
carious  process. 


R .    Zinci  iodi  .    . 
Aquse    .    .    . 

•  gr-xij 

to  xxiv 

M. 

SlGNA.- 
each 
three 

—After  drying  the  gums,  inject 
pus-pocket    with    one,    two  or 
drops  of  this  solution. 

35 

546  DENTAL   MEDICINE. 


ZINCI  OXIDUM— OXIDE  OF  ZINC. 

Formula. — ZnO. 

Derivation. — Oxide  of  zinc  is  obtained  by  subjecting  pre- 
cipitated carbonate  of  zinc  to  a  red  heat,  till  the  whole  of  the 
carbonic  acid  and  water  are  expelled. 

It  is  in  the  form  of  a  yellowish-white  powder,  insoluble  in 
water,  but  soluble  in  dilute  sulphuric  and  hydrochloric  acids, 
without  effervescence.     It  is  inodorous  and  tasteless. 

Medical  Properties  and  Action. — Oxide  of  zinc  is  tonic  and 
antispasmodic,  but  in  large  doses  causes  vomiting  and  purg- 
ing ;  by  graduall}^  increasing  the  dose,  large  quantities  can  be 
taken  without  injurious  effects.  It  should  never  be  given  on 
an  empty  stomach,  as  it  may  cause  nausea. 

Therapeutic  Uses. — It  is  employed  in  spasmodic  asthma, 
convulsions  of  children,  epilepsy,  chorea,  whooping-cough, 
hysteria,  and  is  an  excellent  remedy  for  gastralgia ;  also  in 
chronic  diarrhoea  and  chronic  dysentery. 

Dose. — Of  oxide  of  zinc,  gr.  ss  to  gr.  x. 

Dental  Uses. — Oxide  of  zinc  may  be  employed  in  the  treat- 
ment of  convulsions  of  children  during  dentition,  given  in  doses 
of  gr.  ss  to  gr.  v,  gradually  increased  to  gr.  viij,  in  powder, 
with  a  little  sugar.  It  is  also  combined  with  carbolic  acid,  in 
a  fluid  form,  for  capping  exposed  pulps,  being  applied  in  the 
form  of  a  paste  to  the  exposed  surface  of  the  dental  pulp.  It 
also  forms  an  ingredient  of  the  zinc-filling  materials,  and  of 
the  celluloid  base  for  artificial  teeth.  Dr.  Edw.  Eggelston 
recommends  a  combination  of  oxyphosphate  and  gutta-percha 
as  a  filling  material  for  large  cavities  in  proximal  surfaces  of 
posterior  teeth,  extending  below  gum  margin.  The  cavity  is 
first  filled  one-third  full  of  gutta-percha  and  completed  with 
the  oxyphosphate.  It  is  generally  supposed  that  alkalies, 
especially  ammonia,  have  more  effect  in  disintegrating  oxy- 
phosphate fillings  in  the  mouth  than  have  acids. 


SULPHATE   OF   ZINC. 


547 


DENTAL    FORMULA. 


Oxypkosphate  of  Zinc  Preparation  for 
Filling  Teeth. 


R .    Zinci  oxidi partes  200 

Silicii  (fine  powd.)  .  .  partes  viij 
Sodii  boratis    ....  partes  iv 

Pulv.  glass partes  v. 

Levigate  under  water  to  ensure  com- 
plete admixture,  and  dry  by  evapora- 
tion ;  then  calcine  at  white  heat;  then 
reduce  to  powder. 

LIQUID. 

li .    Acidi  phosphorici, 

Aquae q.  s.   to   dissolve, 

and  evaporate  the  solution  by  aid  ot 
heat,  until  it  is  of  the  consistence  of 
glycerin. 

Another  Formula  for  the  Oxyphos- 
phate  Preparation,  in  which  simply  the 
calcined  oxide  of  zinc  and  glacial  phos- 
phoric acid  are  employed,  is  prepared 
as  follows  : — 

Calcine  the  oxide  of  zinc  for  two 
hours,  at  a  white  heat,  or  until  it  be- 
comes a  hard,  yellowish  mass ;  then 
pulverize  in  a  mortar,  and  sieve  through 
fine  bolting  cloth.  For  the  liquid  take 
^j  of  glacial  phosphoric  acid  (German), 
in  crystals,  and  dissolve  in  f^j  of 
water,  and  then  evaporate  to  one-third, 
on  a  sand  bath. 


Oxychloride  of  Zinc  Preparation  for 
Filling  Teeth. 

FOR  THE  POWDER. 

R  .    Zinci  oxidi gr.xxx 

Sodii  boratis gr.ij 

Silicii  (fine  powd.j.  .  .  gr.j. 
Mix  thoroughly  and  subject  to  a 
bright-red  heat  in  a  crucible.  Then 
grind  this  frit  to  a  powder,  and  mix  it 
with  three  times  its  weight  of  calcined 
oxide  of  zinc. 

FOR    THE    LIQUID. 

R.    Zinci  chloridi  (deliq. )    .  f^j 

Aquae f^vtovj. 

For  Neuralgia  of  the  Head. 
Von  Niemeyer. 
R .    Ext.  hyoscyami, 

Zinci  oxidi aa  ^ij.     M. 

SiGNA. — Fiat  pill,  xj. 

Begin  with  one  pill  morning  and 
evening,  and  increase  to  xx  or  xxx 
daily. 

For  Pulp  Devitalization. 

Dr.  Crissman. 

White  oxide  of  zinc  .    .    .  ^ 


R. 


Hydrochlorate  of  Cocaine, 

crystals  of )/% 

Creosote  q.  s.  to  make  a  paste. 
After  removal,  apply  tannin  dissolved 
in  glycerine  or  alcohol. 


ZINCI  SULPHAS— SULPHATE  OF  ZINC. 

Formula, — ZnSO^+zHaO. 

Derivation. — Sulphate  of  zinc  is  obtained  by  the  action  of 
sulphuric  acid  on  granulated  zinc,  the  solution  being  purified 
by  means  of  chlorine  and  carbonate  of  zinc,  and  afterwards 
evaporated,  the  product  being  crystals  of  sulphate  of  zinc.  It 
is  in  the  form  of  colorless  crystals,  which  effloresce  on  expo- 
sure to  air,  and  are  soluble  in  water  and  insoluble  in  alcohol, 


548  DENTAL   MEDICINE. 


resembling  in  appearance  Epsom  salts.  It  has  a  disagreeable, 
metallic,  styptic  taste. 

Medical  Properties  and  Action. — Sulphate  of  zinc  is  tonic, 
astringent,  antispasmodic,  and,  in  large  doses,  emetic.  Exter- 
nally, it  is  stimulant  and  astringent.  When  its  use  is  long 
continued,  it  produces  symptoms  like  those  of  lead.  When 
administered  in  proper  doses,  it  exerts  an  antispasmodic  in- 
fluence on  the  nervous  system,  and  where  there  is  spasm  and 
convulsion,  it  is  very  serviceable. 

Therapeutic  Uses. — It  is  internally  administered  in  epilepsy, 
chorea,  hysteria,  angina  pectoris,  chronic  dysentery,  flatulence, 
night  sweats  of  phthisis,  etc.,  and  is  a  prompt  emetic  in  cases 
of  narcotic  poisoning.  Internally,  it  is  employed  in  the  treat- 
ment of  gonorrhoea  of  the  eye,  chronic  skin  diseases,  epitheli- 
oma, ulcers,  gangrene,  etc. 

Dose. — Of  sulphate  of  zinc,  gr.  Y^  to  gr.  vi.  For  an  emetic 
in  cases  of  poisoning  six  grains  will  prove  sufficient,  well 
diluted  with  water,  and  repeated  every  fifteen  minutes  until 
emesis  occurs. 

Deyital  Uses. — Sulphate  of  zinc  is  employed  externally  in 
dental  practice,  in  gangrene  of  the  mouth,  disease  of  the  an- 
trum, ulcerations  of  mucous  membrane,  and  indolent  ulcers, 
acting  as  a  stimulant  and  astringent. 

Dr.  Northrop  recommends  for  Alveolar  Pyorrhoea  a  satura- 
ted solution  of  sulphate  of  zinc,  a  saturated  solution  of  iodide 
of  potassium,  equal  parts,  which  combination  in  turn  is  satu- 
rated with  the  crystals  of  iodine. 

DENTAL    FORMULA. 
For  Gang7-ene  of  the  Mouth  {Cancrum      For  Ulceration  of  Mucous  Membrane  of 


Oris. 


he  Mouth. 


R .    Zinci  sulphat gr.xx  g      Jaucx  sulphat.  .    .    .    gr.j  to  v 

Mellis gj.      M.  Aqua  destillatse  .    .  gj.  M. 

SiGNA. — To  be  applied  with  a   camel's  SiGNA. — To    be   used    as    a  gargle  or 
hair  brush.  lotion. 


ANTISEPTICS   IN   DENTAL   PRACTICE.  549 

For  Chronic  Alveolar  Abscesses,  Abscess  of  Antrum,  etc. 
G.  L.  Parmele. 

R.        Zinci  sulphat gr.iij 

Plumbi  acetatis gr.v 

Tine,  catechu gtt.x 

Aquas f  ^j.  M. 

SiGNA. — Use  as  a  stimulating  injection. 

ANTISEPTICS  IN  DENTAL  PRACTICE. 

The  term  a7itiseptis  implies  the  prevention  of  septic  influence 
or  putrefaction  in  wounds,  and  the  healing  of  wounds  by  first 
intention  or  without  suppuration. 

Antiseptics  are  medicinal  substances  which  possess  the  power 
of  arresting  the  process  of  putrefaction,  and  they  embrace  such 
drugs  as  organic  (vegetable)  acids,  inorganic  (mineral)  acids, 
the  former,  such  as  carbolic,  salicylic  and  benzoic  acids  being 
applicable  to  tooth-structures  and  tooth-tissues ;  while  the 
latter,  such  as  nitric,  sulphuric,  hydrochloric,  boracic  and 
chromic  acids  are  restricted  to  the  treatment  of  tooth-tissues  ; 
also,  the  iodides,  which  include  the  tincture  of  iodine,  iodo- 
form, iodol,  potassium  iodide,  aseptol,  aristol;  also  the  mer- 
curials, such  as  the  bichloride  and  biniodide  of  mercury ;  also 
such  oxidizing  agents  as  peroxide  of  hydrogen  and  perman- 
ganate of  potash  ;  also  the  essential  oils,  such  as  cajuput,  cassia 
peppermint,  cloves,  thyme,  turpentine,  caraway,  mustard,  eu- 
calyptus, juniper,  gaultheria,  cinnamon,  eugenol,  sassafras, 
pennyroyal,  valerian,  etc.;  also  the  wood  and  coal-tar  deri- 
vatives, such  as  creasote,  hydronaphthol,  resorcin,  lysol,  etc.; 
also  heat.  The  methods  of  using  antiseptics  in  dental  prac- 
tice are  by  irrigation,  disinfection,  and  as  antiseptic  dressings. 
Irrigation  consists  in  washing  out  cavities  in  teeth,  applica- 
tions to  inflamed  and  infected  surfaces,  syringing  abscesses, 
and  the  use  of  mouth-washes  or  lotions,  diluted  aqueous  solu- 
tions or  antiseptic  agents  being  considered  preferable  to  con- 
centrated solutions  for  such  purposes. 

Disinfection  consists  in  the  destruction  of  micro-organisms 
and  the  products  of  fermentation  and  putrefaction  in  carious 
cavities,  pulp-canals,  gangrenous  pulps,  etc. 


550  DENTAL   MEDICINE. 


Antiseptic  dressings  or  applications  are  in  the  form  of  pow- 
ders, solutions  and  pastes,  or  mixed  with  filling  materials,  such 
as  the  preparations  of  zinc.  When  acids  are  used  as  anti- 
septics, they  must  be  so  diluted  as  to  deprive  them  of  their 
caustic  properties  or  action,  and  the  mercurials,  such  as  the 
bichloride,  must  be  in  such  weak  solutions  as  will  prevent 
toxic  effects  on  the  system.  Different  antiseptics  are  required 
according  to  the  anatomical  structure  of  the  part  on  which 
they  are  to  act,  and  also  its  physical  condition,  as  the  inflam- 
mation present  may  be  either  acute,  or  chronic,  or  the  tissue 
be  in  a  septic  or  putrescent  state ;  hence,  each  condition 
demands  a  particular  class  of  antiseptics.  The  strength  of 
the  antiseptic  employed  will  also  depend  upon  the  condition 
of  the  tissue  or  structure  at  the  time  of  application.  Dr.  W. 
D.  Miller  has  established  the  relationship  of  micro-organisms 
to  the  etiology  of  dental  caries,  and  also  shown  that  all  fermen- 
tative and  putrefactive  processes  of  the  dental  pulp  and  oral 
mucous  membrane  are  conditioned  by  the  presence  of  living 
bacteria.  From  recent  experiments  made  by  Dr.  Miller  on  the 
comparative  value  of  antiseptics  for  sterilizing  cavities,  etc.,  he 
concludes  that  bichloride  of  mercury,  "  which  usually  ranks  as 
the  king  among  antiseptics,"  and  gave  uniformly  good  results, 
in  one  method  he  employed,  fell  considerably  short  of  the 
striking  action  shown  by  the  trichloride  of  iodine,  and  he 
further  remarks  that  "  we  have  consequently  reasons  to  hope 
that  the  trichloride  of  iodine  may  prove  a  valuable  remedy  in 
the  treatment  of  diseased  conditions  of  the  teeth  and  mouth, 
and  that  the  five  per  cent,  solution  is  one  of  the  most  active 
agents  at  our  demand  for  disinfecting  carious  dentine.  Of 
carbolic  acid,  he  says,  while  it  is  a  very  active  antiseptic  agent, 
it  falls  considerably  behind  the  bichloride  of  mercury  and  tri- 
chloride of  iodine  in  its  penetrating  power.  Of  lysol  and  tri- 
chlorphenol,  he  says  that  the  results  were  very  similar  to  those 
obtained  by  carbolic  acid.  Of  peroxide  of  hydrogen,  he  says, 
that  although  it  is  an  excellent  sterilizer  for  thin  layers  of 
carious  dentine,  it  fails  when  applied  to  thicker  ones,  as  anti- 
septics applied  to  cavities  of  decay  on  cotton  naturally  retain 


ANTISEPTICS    IN    DENTAL    PRACTICE.  55I 

their  power  but  a  few  hours;  pledgets  of  cotton  saturated  with 
carbolic  acid  and  placed  in  large  cavities  near  the  gums,  lose 
their  antiseptic  action  in  twenty-four  hours.  Of  chloride  of 
zinc,  he  thinks  that  although  it  penetrates  the  tissue  quite 
rapidly,  yet  its  antiseptic  power  is  inferior  to  that  of  many  other 
available  antiseptics,  and  that  the  pain  attending  its  applica- 
tion to  the  nearly  exposed  pulp,  more  than  counterbalances 
any  slight  advantage  it  might  otherwise  have  over  carbolic 
acid. 

Hydronaphthol  showed  considerable  penetrating,  antiseptic 
and  consequently  preservative  action.  Iodoform  he  considers 
to  be  one  of  the  most  worthless  antiseptics,  and  that  this  fact 
has  not  been  revealed  long  ago  is  in  part  due  to  the  circum- 
stance that  it  is  nearly  always  employed  in  conjunction  with 
some  other  material,  such  as  carbolic  acid,  oil  of  cloves,  etc. 

The  essential  oils,  pyoktanin,  benzoic  acid,  alcohol,  thymol 
and  resorcin,  all  fell  far  short  of  the  standard  of  efficiency 
maintained  by  other  antiseptics  for  sterilizing  carious  cavities. 
He  found  that  thymol  and  salicylic  acid  manifested  an  evident 
preservative  action  upon  the  dental  pulp,  but  the  effects  were  • 
confined  to  a  small  portion  of  the  pulp.  Of  the  two,  thymol 
gave  the  better  results.  Of  the  aniline  colors  methyl  violet 
and  methylene  blue,  neither,  he  says,  has  the  slightest  pre- 
servative action,  nor  did  they  penetrate  the  pulps  to  a  depth 
of  more  than  a  quarter  of  an  inch.  Campho-phenique,  he 
says,  appeared  to  penetrate  the  pulp-tissue  about  as  rapidly  as 
carbolic  acid,  and  moderately  hardened  the  tissue,  giving  to  it 
antiseptic  properties  by  the  absorption  of  the  solution,  but  not 
equal  to  that  imparted  by  carbolic  acid  alone. 

The  antiseptics  Dr.  Miller  found  to  be  pre-eminently  active 
in  preventing  decomposition  of  pulp-tissue,  were :  bichloride 
of  mercury,  cyanide  of  mercury  (?),  trichlorphenol,  sulphate 
of  copper,  carbolic  acid,  oil  of  cloves,  chloride  of  zinc, 
campho-phenique  (?),  hydronaphthol  (?). 

Those  of  doubtful  value  :  thymol,  salicylic  acid,  eugenol,  a 
and  b  naphthol,  acetico-tartrate  of  aluminium,  five  per  cent,  solu- 
tion of  bichloride  of  mercury,  and  possibly  some  essential  oils. 


552  DENTAL   MEDICINE. 


According  to  Dr.  Black,  "  infectious  matter  contains  living 
particles  that  will   grow  and   reproduce  themselves.     Septic 
matter  may  be  in  solution ;  it  is  poisonous.     It  is  the  product 
of  the   growth  of  micro-organisms,  and  it  is  this  product  of 
the  dentine  that  is  dangerous  in  many  cases,  to  the  exclusion 
of  infectious  matter ;  for  while  infectious  matter  may  be  in  the 
dentine,  may  live  there   for  a  time,  it  certainly  will  not  live 
there  very  long  if  communication  by  which  it  receives  food  is 
cut  off.     It  must  receive  food  in  any  case,  and  must  get  clear 
of   its  waste    products  or  it  will  soon  be  choked.     Though 
microbes  may  not  be  present  in  the  dentine,  there  is  danger  of 
poisoning  from  the  septic  matter  that  is   absorbed,  filling  the 
dentinal  tubules.     We  have  a  different  set  of  conditions  when 
we  leave  a  little  bit  of  softened  dentine  over  a  pulp  nearly  ex- 
posed.    We  may  cover  in  the  anaerobic  microbes.     In  a  short 
time  they  produce  products  that  will  destroy  the  pulp,  or  they 
may  pass  through  and  penetrate  into  the  pulp,  and  we  may 
have  an  infected  pulp  presently  from  the  microbes  we  have 
covered  in.     This  action  is  brought    about  rapidly,  and  the 
poisonous    matter    escapes    toward    the    pulp.     If   we    have 
covered  them  in  with  the  filling  we  have  sealed  up  the  ele- 
ments for  destroying  that  pulp.     It  is  not  necessary  that  the 
dentine  be  softened  more  ;  it  may  not  be  a  class  of  microbes  that 
soften  dentine.     It  is  a  microbe  that  attacks  the  sarcous  ele- 
ments of  the  body ;    the  contents  of  the  dentinal  tubes  are 
attacked  just  as  well.     So  here  we  need  a  disinfectant.     What 
shall  we  use  ?     Certainly  not  one  of  the   coagulants   (such  as 
carbolic  acid,  creasote  and  chloride  of  zinc — agents  which  seal 
the  septic  matters  within  the  teeth) ;  certainly  not  one  that  places 
a  barrier  to  its  own  penetration  by  coagulating  the  albumen. 
These  are  not  the  antiseptics  you  should  use  in  this  place,  but 
something  we  can  depend  upon  to  penetrate  in  the  presence 
of    albumen,  and    we   find   that    to-day    in    the   use    of  the 
essential  oils,  and   among  them   the  oil  of  cassia  is  the  most 
potent.     There  are  many  of  the  essential  oils  that  when  used 
in  substance  will  destroy  microbes  just  as  quickly  as  the  oil 
of  cassia,  and    among   them    may  be    mentioned   the    oil  of 


ANTISEPTICS    IN    DENTAL  PRACTICE.  553 

turpentine,  but  there  is  none  of  them  that  will  destroy 
microbes  so  rapidly  and  so  certainly  with  that  proportion  of 
the  oil  that  will  dissolve  in  water,  or  the  fluid  with  which  they 
come  in  contact  in  their  application  in  practice  as  the  oil  of 
cassia.  In  bacteriology,  the  terms  ger^n,  bacteria,  microbe, 
schizornycetes,  are  used  almost  as  synonymous  names,  but 
microbe  seems  preferable  to  germ  or  bacteria,  and  schizomy- 
cetes  is  considered  to  be  a  better  scientific  term  than  either. 
It  is  also  conceded  that  these  are  unicellular  and  assimilate 
nourishment  apparently  by  absorption  in  the  media  in  which 
they  live,  but  they  must  alter  their  foods  found  proper,  and 
yet  unfit  in  nature  for  their  use  and  appropriation.  Bacteria, 
living  or  dead  matter  encounter  no  living  resistance,  while 
those  feeding  on  living  tissues,  or  fluids  in  living  tissues,  meet 
the  living  cells  of  the  body  and  have  to  combat  them.  The 
diastases  secreted  by  the  various  beings,  whether  highly 
organized,  or  unicellular  and  microscopic,  have  something  in 
common  as  to  their  respective  objects  and  their  properties  of 
transforming  matter.  The  roll  of  microbes  in  existence  is 
complex  and  necessary,  though  some  are  injurious.  They  act 
as  scavengers,  return  to  the  air  and  water  the  organizable  ele- 
ments abstracted  daily  by  the  vegetables  and  indirectly  by 
animals,  and  are  indispensable  to  life.  The  bacteria  that  in- 
vade living  organisms  which  happen  to  be  fit  for  their  nourish- 
ment and  growth  are  considered  to  be  parasites.  The  spon- 
taneous generation  of  living  organisms,  no  matter  how  little, 
is  now  regarded  as  a  fallacy. 

Formerly,  when  the  root-canal  of  a  tooth  was  opened  and 
found  to  be  empty  and  dry,  peridental  trouble  resulted.  But 
the  treatment  of  such  cases,  as  now  pursued,  consists  in  ex- 
cluding the  saliva  and  atmospheric  microbes,  the  removal  of 
every  particle  of  debris,  and  the  application  of  antiseptics  and 
disinfectants.  To  render  a  pulp-canal  permanently  aseptic,  it 
should  be  thoroughly  cleansed  with  either  alcohol,  peroxide 
of  hydrogen  or  ammonia,  using  a  syringe  to  prevent  septic 
matter  being  forced  through  the  foramen.  After  the  alcohol 
has  evaporated,  or  the  canal  thoroughly  dried  of  the  peroxide 


554  DENTAL   MEDICINE. 


of  hydrogen  or  ammonia,  by  means  of  a  hot-air  syringe,  an 
application  of  the  bichloride  of  mercury  or  other  antiseptic  is 
then  made,  and  the  canal  rendered  permanently  aseptic.  In 
an  open  pulp-canal  containing  partly  devitalized  pulp  tissue, 
the  same  care  must  be  exercised  to  cleanse,  disinfect  and 
render  aseptic.  When  alveolar  abscess  exists  as  the  result  of 
a  devitalized  pulp,  similar  treatment  is  indicated;  and  in  all 
cases  where  a  pulp  has  been  destroyed  by  therapeutic  remedies 
or  agents,  the  treatment  consists  in  cleansing,  disinfecting  and 
filling  the  pulp-canals. 

Dr.  A.  W.  Harlan  remarks  :  "  All  cavities  in  living  and 
pulpless  teeth  are  infected  through  the  agency  of  patho- 
genic bacteria  or  micrococci.  (Black,  Milles,  Underwood  and 
Miller.)  These  micro-organisms  and  other  septic  matters 
cannot  be  destroyed  in  excavating  a  cavity  in  a  living  tooth 
short  of  destruction  of  the  pulp  by  coagulating  drugs  save  in 
rare  instances.  Dilute  solutions  of  bichloride  of  mercury, 
peroxide  of  hydrogen  and  some  of  the  naphthol  compounds, 
belong  to  this  class ;  coagulators  cannot  be  used  in  a  suffici- 
ently diluted  state  to  accomplish  disinfection  without  injury  to 
the  parts  to  which  they  are  applied.  Diffusible  drugs  will 
destroy  septic  materials,  including  cause  of  infection,  without 
injury  to  the  living  hard  or  soft  tissues.  The  above  will  apply 
as  well  to  infected  pulpless  teeth,  arid  this  is  even  true  with 
reference  to  the  coagulation  of  the  exposed  organic  matrix  in 
the  interior  of  a  tooth  partly  softened  by  caries.  Coagulating 
agents  simply  coagulate  and  leave  the  coagulum  to  become  a 
source  of  food  supply  to  the  serobic  and  anaerobic  microbes." 

Dr.  Harlan  recommends  the  following  for  softened  dentine  : 
Corrosive  sublimate,  peroxide  of  hydrogen  and  tartaric  acid 
combined,  applied  with  wood  or  platinum  points ;  then  dry 
the  cavity  and  apply  myrtol  in  full  strength  and  dry  it  again. 
He  also  says  :  If  it  is  deemed  a  necessity  to  apply  an  anti- 
septic agent  to  a  cavity  in  a  tooth  having  a  living  pulp,  an  oil 
(one  of  the  essential  oils,  such  as  peppermint,  camphor,  tur- 
pentine, thyme,  cassia,  cinnamon,  caraway,  eugenol,  cajuput, 
eucalyptol,  terpinol,  myrtol,  sassafras),  may  be  left  in  contact 


ANTISEPTICS   IN   DENTAL   PRACTICE.  555 


with  the  cavity,  sealed  with  gutta  percha,  or  the  cavity  may 
be  stopped  with  oxysulphate  of  zinc  for  any  number  of  days. 
The  cavity  should  be  well  dried  before  introducing  the  oil.  He 
.also  remarks  that  there  is  no  theoretical  objection  to  the  use 
of  carbolic  acid  in  a  living  tooth,  if  it  is  reapplied  from  time  to 
time  perfectly  warmed.  It  should  not  be  used  to  protect  the 
pulp  from  the  invasion  of  micro-organisms  or  deep-seated 
cavities,  as  it  will  prove  inadequate  by  lack  of  diffusibility. 

"  It  is  a  mistaken  idea  to  suppose  that  an  agent  like  carbolic 
acid,  liquefied  or  diluted  with  water,  will  prove  a  permanent 
antiseptic  in  the  presence  of  moisture,  such  as  is  nearly  always 
present  in  a  tooth.  It  does  not  possess  embalming  properties 
because  it  is  easily  absorbed  and  disappears.  It  should  form 
no  part  of  root-filling,  nor  should  it  be  introduced  into  roots 
permanently.  Copal,  Canada  balsam,  or  other  agents  of  this 
class,  may  be  used  on  an  exposed  pulp  in  its  stead,  and  for  in- 
jection into  abscesses,  using  the  root  of  the  tooth  as  a  channel, 
potass-permanganate,  silico-fluoride  of  sodium,  boro-glycerine, 
the  oil  of  cloves,  cassia,  cinnamon,  myrtol,  and  agents  of  this 
class,  are  far  more  powerful,  with  better  stimulating,  antiseptic 
and  disinfectant  properties,  and  they  do  not  possess  the  coag- 
ulating properties  of  carbolic  acid,  or  its  disagreeable  odor, 
and  under  no  circumstances  will  they  clog  a  delicate  canal  or 
destroy  the  soft  tissue  to  which  they  are  applied.  Carbolic 
acid  should  take  its  legitimate  place  as  a  spray,  a  local  anaes- 
thetic and  component  of  mouth-washes  in  dental  practice,  and 
as  an  adjuvant  to  the  oils  where  local  medication  around  the 
roots  of  teeth  may  be  indicated,  or  for  injection  into  the  antrum 
of  Highmore,  combined  with  tannin,  glycerine,  camphor  or 
potash,  or  be  relegated  to  the  laboratory  as  a  component  of 
sodium  phenate,  or  in  other  chemical  uses." 

Dr.  W.  D.  Miller,  in  a  recent  article  on  the  disinfection  of 
dental  and  surgical  instruments,  says  :  "  There  is  no  depart- 
ment of  surgery  in  which  the  demand  for  antiseptic  procedure 
is  more  urgent  than  in  dentistry,  for  the  reason  that  all  of  our 
operations  are  performed  upon  septic  or  infected  tissues,  and 
we  have  no  means  of  rendering  the  territory   to   be  operated 


556  DENTAL   MEDICINE. 


upon  aseptic  except  by  the  use  of  antiseptics  of  the  highest 
character.  We  cannot  extract  a  tooth,  cleanse;  the  canal  of  a 
pulpless  tooth,  excavate  a  cavity  of  decay  or  lance  the  gums  ; 
we  cannot  even  touch  any  point  in  the  oral  cavity  without  our  . 
instruments  becoming  coated  with  a  layer  of  infectious  material. 
We  are  therefore  bound  to  use  antiseptics,  not  only  for  the 
purpose  of  disinfecting  the  already  infected  tissues,  but  for 
sterilizing  our  instruments  to  avoid  the  transmission  of  infec- 
tious matter  from  one  patient  to  another."  "  The  necessity 
for  absolute  cleanliness  on  the  part  of  the  dentist,  of  his  hands 
as  well  as  of  his  instruments,  napkins,  drinking-glasses,  rub- 
ber-dam, in  short  of  everything  with  which  he  comes  in  con- 
tact with  the  patient's  mouth,  is  universally  recognized  ;  at 
least  there  can  be  no  one  who  has  the  courage  to  express  a 
contrary  opinion."  "  We  can  never  know  what  virus  may  be 
clinging  to  our  instruments,  nor  can  we  with  certainty  predict 
the  result  of  a  wound  upon  the  gums,  cheeks  or  lips  with  an 
unclean  instrument." 

From  Dr.  Miller's  experiments  we  deduct  the  following : 
Boiling  napkins  for  lo  or  15  minutes  in  soap-water  completely 
sterilizes  them.  Small  pieces  of  rubber-dam  can  be  sterilized 
as  a  rule  by  exposing  them  for  30  minutes  to  a  five  per  cent, 
solution  of  carbolic  acid  ;  but  boiling  small  and  large  pieces 
of  the  dam  are  completely  sterilized  by  subjecting  them  to 
boiling  water  for  from  six  to  fifteen  minutes,  according  to 
size. 

Drinking  or  rinsing  glasses  can  be  sterilized  by  boiling  in 
pure  water.  Concerning  instruments,  he  says  :  The  ideal  anti- 
septic is  a  liquid  which  acts  immediately  upon  bacteria  without 
in  any  way  injuring  the  instrument.  His  results  were  as  fol- 
lows :  A  five  per  cent,  solution  of  carbolic  acid  required  one 
hour  to  sterilize  instruments,  and  even  after  such  a  time  the 
result  was  not  certain  ;  and  of  twenty-one  pieces  placed  in 
concentrated  carbolic  acid  for  varying  periods  of  time  rang- 
ing from  one  to  twelve  minutes,  only  two  were  sterilized. 

A  five  per  cent,  solution  of  trichlorphenol  required  an  hour's 
time  to  sterilize.     Lysol    gave   results  nearly   identical   with 


ANTISEPTICS   IN   DENTAL   PRACTICE.  557 

those  of  trichlorphenol.  An  action  of  from  fifteen  to  twenty 
minutes  in  a  five  per  cent,  aqueous  solution  of  the  bichloride 
of  mercury  gave  the  most  promising  result  and  can  be  relied 
upon  to  produce  thorough  sterilization;  but  he  considers  the 
time  required  to  be  so  long  as  to  render  a  five  per  cent, 
solution  of  the  bichloride  of  mercury  unsuitable  for  the  pur- 
pose ;  besides  the  powerful  action  of  this  agent  upon  steel  or 
iron  is  a  serious  objection  to  its  use  as  a  sterilizer.  A  ten  per 
cent,  solution  of  the  peroxide  of  hydrogen  came  next  to  car- 
bolic acid,  but  is  considerably  inferior  to  it.  The  essential  oils 
in  emulsion,  as  well  as  in  pure  form  utterly  failed  to  sterilize. 
A  mixed  antiseptic  solution,  composed  of  a  five  per  cent, 
solution  of  trichlorphenol  in  peroxide  of  hydrogen,  acted 
slightly  more  rapidly  than  the  simple  five  per  cent,  aqueous 
solution  of  trichlorphenol,  but  the  improvement  was  not  en- 
couraging. He  finally  concluded  that  boiling  water  is  far 
superior  to  chemical  antiseptics,  and  all  other  means,  for 
sterilizing  dental  instruments,  and  that  its  easy  application  and 
rapid  action  should  recommend  it  to  every  practicing  dentist 
and  physician.  He  regards  an  exposure  of  three  minutes  to 
boiling  water  sufficient  for  sterilizing  the  smaller  dental  instru- 
ments, and  five  minutes  for  any  other.  The  addition  of  soda 
will  prevent  the  rusting  which  is  liable  to  occur  when  the 
instruments  are  boiled  in  water  alone;  hence  a  boiling  solu- 
tion of  carbonate  of  sodium  appears  to  be  the  most  promising, 
Dr.  Miller  recommending  an  exposure  of  three  to  five  minutes 
to  a  boiling  one  or  tv/o  per  cent,  solution  of  soda  for  sterilizing 
dental  and  surgical  instruments.  The  solution  must  not  be 
simply  hot,  but  boiling,  since  the  motion  of  the  boiling  water 
materially  assists  in  rapidly  raising  the  temperature  of  the 
instruments  to  100°  C,  and  at  the  same  time  loosens  up  any 
matter  that  may  be  clinging  to  them. 

Incompatible  Antiseptics. — Corrosive  sublimate  and  iodine; 
corrosive  sublimate  and  soap  ;  iodine  and  soap  ;  carbolic  acid 
and  iodine  ;  carbolic  acid  and  permanganate  of  potassium  ; 
salicylic  acid  and  soap ;  salicylic  acid  and  permanganate  of 
potassium ;    permanganate   of  potassium    and    oils,    soap,   or 


558  DENTAL   MEDICINE. 


glycerine;  aristol  and  caustic  alkalies,  ammonia,  mercuric 
chloride,  metallic  oxides,  starch,  or  any  substance  which  pos- 
sesses a  powerful  affinity  for  iodine. 

TEST-PAPERS   FOR   DENTISTS. 

Very  frequently  it  is  important  to  the  dentist  to  know 
whether  his  peroxide  of  hydrogen,  which  is  so  liable  to 
change,  is  still  good  or  has  become  decomposed  ;  or  whether 
his  solution  of  bichloride  of  mercury  has  become  inert  by 
the  reducing  action  of  organic  matter  in  the  water  under  the 
influence  of  sunlight.  And  so  of  many  other  chemicals  used 
in  the  dental  office  which  are  apt  to  change  in  strength. 
.  Prof  Chas.  Mayr,  of  Springfield,  Mass.,  has  prepared  a 
series  of  test-papers,  which  will  enable  the  dentist  to  learn 
quickly  and  accurately  whether  his  preparations  are  good  or 
worthless,  and  without  the  use  of  cumbersome  methods. 
They  are  put  up  in  neat  little  books,  each  containing  eight 
different  papers  (of  some,  like  litmus,  several  papers  are  pro- 
vided), affording  sixty-four  different  reactions.  The  papers 
are  as  follows : 

Phenyl- Carbinol,  for  strong  acids  and  alkalies. 

Turmeric,  for  alkalies. 

Sulphide,  for  solution  of  metals. 

Potassium  Iodide,  for  H2O2,  bichloride  700. 

Iodide  Starch,  for  hydrogen  peroxide. 

Litmus,  for  weak  acids  and  alkalies. 

Erythorine ,  for  salts  and  alkalies. 

Lacmoid,  substitute  for  litmus,  not  affected  by  carbonic 
acid. 

Each  paper  has  printed  upon  it  the  reactions  it  gives,  so 
that  even  the  inexperienced  have  a  safe  guide  as  to  its  uses. 

NEW  REMEDIES. 

The  following  is  a  list  of  the  new  remedies  more  recently 
introduced,  their  action  and  posology,  which  will  be  found 
useful  as  a  matter  of  reference : 


NEW  REMEDIES.  559 


Therapeutic  Uses.  Dose. 

Acetylphenylhydrazin  .  Antipyretic  and  analgesic    .    .    .    .  3  to  5  grs.  per  os. 

Agaricine Antisudoritic  in  phthisis ^  gr.  per  os. 

Anthrarobin Against  skin  diseases 

Benzoyl-anilide     .    .    .  Antipyretic I  ^  to  5  grs.  per  os. 

Benzoylgaiacol ....  Antituberculotic    .        4  to  10  grs.  per  os. 

Bismuth  saHcylate    .    .  Against  gastric  affections    .    .    .    .  6  to  15  grs.  per  os. 

Bromoform Against  pertussis i  to  2  min.  per  os. 

Camphoric  acid         .    .  Antisudorific  in  phthisis,   etc.     .    .  30  grs.  per  os. 

Cetrarin Stomachic 2  grs.  per  os. 

Chloralurethan      .    .    .  Hypnotic 15  to  45  grs.  per  os. 

Ethylenimine       hydro- 
chloride      General  stimulant 3^  to  )^  gr.  subcutane- 

ously. 

Exalgine Analgesic 4  grs. 

Hydrastinine     ....  Against  uterine  hemorrhage    ...  I  gm.   subcutaneously. 

Hydroxylamine     .        .  Against  skin  diseases Externally. 

Hydracetin See  acetylphenylhydrazine  .... 

Hypnone Hj^pnotic 3  to  8  min.  per  os.    ' 

Iodine  trichloride     .    .  Antiseptic Externally    in     I     per 

cent,  of  solution. 

Iodoform  bituminate     .  Antiseptic Externally. 

Mercury  phenate  .    .    .  Antisyphilitic /^  to  ^  gr.  subcutane- 
ously. 

Mercury  peptoglutine  .  Antisyphilitic ^  gr.  subcutaneously. 

Mercury  salicylate    .    .  Antisyphilitic .    .    .  ^  to  ^  gr.  subcutane- 
ously. 

Mercury  succinimate    .  Antisyphilitic 

Methacetin Antipyretic 3  grs.  per  os.  for  chil- 
dren. 

Methylal Hypnotic  and  anaesthetic    .    .    .    .  15  to  30  grs.  per  os. 

Monobromacetanilide  .  Analgesic i  to  8  grs.  per.  os. 

Naphtholic  acid    .    .    .  Antiseptic  and  antiparasitic    .    .    . 

Naphthol  camphoratum  Antiseptic  antitubercuolotic    .    .    .  Subcutaneously. 

Orexin  hydrochloride  .  Stomachic ^  grs.  per  os. 

Phenylurethan  ....  Antifebrile,  antirheumatic    .    .    .    .  6  to  8  grs.  per  os. 

Piperazide    hydrochlo- 
ride     General  stimulant Externally. 

Pyridine Antiseptic i  to  i^  drs.  by  inhala- 
tion. 

Pyrodin See  acetylphenylhydrazine  .... 

Rubidium     ammonium 

bromide Antiepileptic .'    .  ^  to  i^  drs.  per  os. 

Salipyrin Antifebrile,  antirheumatic    .    .    .    .15  grs.  per  os. 

Sodium  theobromine  sa- 
licylate   Diuretic 8  to  15  grs.  per  os. 

Sodium  anisate     .    .    .  Antipyretic,  antirheumatic  ....  15  grs.  per  os. 


560  DENTAL   MEDICINE. 


Therapeutic  Uses.  Dose. 

Sodium  dithiosalicylate  Antipyretic,  antirheumatic  ....  3  grs.  per  os. 
Sodium  paracresotate  .  Antipyretic,  antirheumatic  .    .    .    .  8  to  15  grs.  per  os. 

Somnal Hypnotic 30  min.  per  os. 

Sozoiodol Antiseptic Externally. 

Sulphaminol Antiseptic Externally. 

Tetronal    ......  Hypnotic 15  to  30  grs.  per  os. 

Thallin  sulphate   .    .    .  Antigonorrhoic Injection. 

Thiol Ichthyol  substitute  q.  v.  .    .    .    .    . 

Tribromphenol ....  Antiseptic Externally. 

Trional Hypnotic I5  to  30  grs.  per  os. 

Thioresorcin Antiseptic 

ERUPTION   OF   THE   TEETH. 

TEMPORARY   TEETH. 

(The  inferior  generally  precede  the  superior  by  two  or  three  months.) 

Central  incisors 5  to    8  months 

Lateral  incisors 7  to  10      " 

First  molars 12  to  16      " 

Canines    .    .    . 14  to  20       " 

Second  molars 20  to  36       " 

The  following  diagram,  by  Dr.  Louis  Starr,*  shows  the 
grouping,  the  date  of  eruption  and  the  duration  of  the  pauses 
between  the  appearance  of  each  group  of  temporary  teeth. 

The  numbers  i  to  5  indicate  the  groups  to  which  the  in- 
dividual teeth  belong  and  their  order  of  appearance,  and  the 
letters  a  and  b  the  precedence  of  eruption  in  the  different 
groups., 

*  Diseases  of  the  Digestive  Organs  in  Children,  Philadelphia,  1891. 


ERUPTION   OF  THE   TEETH. 


561 


EXPLANATION  OF  DIAGRAM. 

1.  I.  Between  the  fourth  and  seventh  months.     Pause  of  3  to  9  weeks. 

2.  2.  2.  2.  Between  the  eighth  and  tenth  months.     Pause  of  6  to  12  weeks, 

3-  3-  3-  3-  3-  3-  Between  the  twelfth  and  fifteenth  months.     Pause  until  the 
eighteenth  month. 

4.  4.  4.  4.  Between  the  eighteenth  and  twenty-fourth  months.     Pause  of  2  to  3 
months. 

5.  5-  5-  5-  Between  the  twentieth  and  thirtieth  months. 


First  molars    . 
Central  incisors 
Lateral  incisors 
First  bicuspids    , 

36 


PERMANENT  TEETH. 

5  to    6  years.  Second  bicuspids   10  to  12  years. 

6  to    8     "  Canines    ....  11  to  13     " 

7  to    9     "  Second  molars  .  .  12  to  14     " 
9  to  TO     "  Third  molars   ,    .  171021     " 


AUTHORITIES  CONSULTED. 


Pharmacopoeia  of  the  United  States. 

Bartholow's  Materia  Medica  and  Therapeutics. 

United  States  Dispensatory. 

Braithwaite's  Retrospect. 

National  Dispensatory. 

Blakiston's  Physician's  Visiting  List. 

Biddle's  Materia  Medica. 

British  Pharmacopoeia. 

American  Journal  of  Medical  Sciences. 

London  Lancet. 

British  Medical  Journal. 

Medical  and  Surgical  Reporter. 

Stille's  Therapeutics  and  Materia  Medica. 

Taylor  on  Poisons. 

Tanner  on  Poisons. 

Wood's  Therapeutics,  Materia  Medica  and  Toxicology. 

Medical  Record. 

New  York  Medical  Journal. 

Ure's  Dictionary. 

Therapeutic  Handbook  of  the  United  States  Pharmacopoeia. 

Universal  Cyclopaedia — A.  McLane  Hamilton. 

Compendium  of  Medical  Science. 

American  Journal  of  Dental  Science. 

Dental  Cosmos. 

Dental  Register. 

Ohio  State  Journal  of  Dental  Science. 

London  Dental  Record. 

British  Journal  of  Dental  Science. 

Garretson's  Oral  Surgery. 

Tanner's  Index  to  Diseases. 

Pareira's  Materia  Medica  and  Therapeutics. 

American  System  of  Dentistry. 

Western  Dental  Journal. 

Items  of  Interest. 

Dental  Advertiser. 

Odontographic  Journal. 

Dental  Revievi^. 

International  Dental  Journal. 

Therapeutic  Gazette. 

Items  of  Interest. 

Quain's  Dictionary  of  Medicine. 

Shoemaker's  Materia  Medica  and  Therapeutics. 

Tumbull's  Artificial  Ansesthesia. 

Gould's  Medical  Dictionary. 

Duane's  Medical  Dictionary. 

Dunglison's  Medical  Dictionary. 

Simon's  Chemistry. 

562 


INDBX 


TO 


DISEASES  AND  DENTAL  FORMULARY. 


ABNORMAL  Dentition _ 46 
Abnormal  Sensitiveness  of  Dentine 70 

Abraded  Surface  of  Mucous  Membrane  of  Mouth     217,272 

Abrasion  of  Teeth 71,    433 

Abrasions  by  Artificial  Dentures 217 

Abscess 29,  50 

of  Antrum 51,  369,  370,  457,  549 

Abscess,  to  abort 222 

Abscess,  Maxillary 53 

Absorption  of  Process  and  Recession  of  Gum 73 

Acidity  and  Pyrosis 278 

Acute  Inflammation  of  Mucous  Membrane  and  Gums 482,  483 

Acute  Tonsillitis 199 

After-pains  of  Tooth- Extraction 48,  195,  247,  292,  314,  433 

Alkaline  Gargle 420 

Alveolar  Abscess  ....  50,  51,  271,  345,  378,,  406,  425,  493,  498,  529,  549 

Hemorrhage 218 

Pyorrhoea  ...  65,  186,  193,  195,  209,  212,  213,  272,  319,  347,  370,  420 
469,  498,  500,  506,  507,  545. 

Ulceration 52 

Analgesic  and  Anodyne 262 

Anasmia 18 

Anesthetics,   General  .  .  .  131,  222,  300,  307,  363,  341,  425,  359,  360,  363 

Local 131,  184,  221,  247,  319,  248,  264,  291,  292,  304,  305,  314 

334,  335,  336,  378,  425- 

Anodyne  Lotion 292,  314 

Antifebrin,  Prescription  for 167 

Antiseptic  Bath  for  Instruments 247 

Antiseptic  Dentifrice 195,  350 

Gargle  or  Mouth  Wash 183,  186,  195,  247,  43S,  469,  529,  530 

Lotion  or  Injection i 193,  194,  209,  402,  469 

Oils 355 

Solution  for  Washing  or  Spraying  Wounds 186,  209 

■Aphthae 63,  201,  212,  268,  307,  354,  382,  383,  415,  517 

Aphthous  Ulcerations  (See  Aphthae) 186,  489,  517 

Arsenical  Poisoning,  Symptoms  of 170 

Astringent  Dentifrice 217 

Lotion,  Gargle  or  Mouth  Wash 199,  217,  218,  413,  435 

Astringent  and  Antiseptic  Gargle 218 

BLACK'S  Antiseptic  Dressing  for  Pulp  Canals  and  Abscesses  195,  357 
Bleaching  Discolored  Teetli  .  .  75,  219,  471,  472,  498,  499,  518,  519 

Boulton's   Preparation 194,  405 

Bruises 222,  272 

Burns 209 

Burnett's  Disinfecting  Fluid 543 

563 


564         INDEX  TO  DISEASES  AND  DENTAL  FORMULARY, 


C A:\IPH0-PHENIQUE  Dentifrice 289 
Canal  Dressing 400 

Cancerous  Tumors 59,  64,  179 

Ulceration 59,  64,  179 

Cancrum  Oris 58,  168,  278,  287,  307,  354,  355,  548 

Capping  for  Exposed  Pulps 186 

Carbolized  or  Carbolate  of  Potash  for  Alveolar  Pyorrhoea,  etc  ....  192 

Styptic 195 

Caries  of  Maxillary  Bones 204,  213 

Chapped  Hands  and  Lips 186,  289,  355,  482 

Chemical  Bleaching  of  Teeth 75 

Chilblains 195,  214 

Chloroform  Narcosis 259 

Chronic  Abscesses  and  Ulcers 218,  382,  406,  549 

Alveolar  Abscesses,  Ulcerations,  etc .  .  .  . 50,  218,  294 

Inflammation  of  Gums  and  Mucous  Membrane 201 

Inflammation  of  Dental  Pulp 69 

Inflammation 34 

Citroline  Dentifrice     351 

Cleft  Palate 62 

Cocaine,  To  make  Solutions  or  Preparations  of 80,  334 

Convulsions  of  Dentition 46,  292 

DANGERS  of  Anesthesia 234,  259 
Dental  Caries 77 

Exostosis,  or  Hypercementosis 71 

Dental  Periostitis  (See  Periodontitis) 

Dentifrices 317,  349,  350,  351,  410 

Dentigerous  C^^sts    59 

Denudation,  or  Erosion 73 

Deodorizers  of  Iodoform 399,  502 

Detergent  [Mouth  Wash  or  Gargle 517 

Devitalizing  Pulps  of  Teeth 179,  180,  399,  433,  530,  547 

Diarrhoea  of  Dentition 46,  213,  278,  394,  395,  457,  458,  487 

Digestive  Stimulation  in  Alveolar  Pyorrhoea 317 

Diphtheritic  Conditions 517 

Discolored  Teeth  (See  Bleaching  Teeth). 

Disease  of  Antrum 268 

Diseases  of  Dental  Pulp 68 

Disinfect  Softened  Dentine 319 

Disinfectant  Mouth  Wash  or  Gargle 194,  208,  493 

Disinfectant  for  Carious  Dentine 319 

Disinfecting  Instruments 555 

Dislocation  of  Jaw     61 

Dressing  for  Children's  Teeth 195 

Dressing  for  Root  Canals,  Abscess,  etc 195 

Dry  Mouth 194 

Dysuria  of  Difficult  Dentition 423 

EARACHE  of  Dentition 314 

Ecchymosis        272 

Edentulous  Neuralgia 72 

Effervescing  Powders    514 

Electro- Magnetism 94 

Emollient  and  Antiseptic  Gargle 209 

Enlarged   Glands 400 


INDEX  TO  DISEASES  AND  DENTAL  FORMULARY.        565 


Epithelioma 64 

Epulis 64 

Erosion  of  Teeth 73 

Erjlhema 509 

Excessive  Sweating  of  the  Hands 407 

Exostosis,  Dental 71 

Exposed   Pulps 292,  305,  334,  336 

FACIAL  Neuralgia 167,  273,  274,  425,  484,  505,  539,  541 
Paralysis 62 

Febrile  Excitement  of  Dentition 395 

Fetid   Perspiration 194,    493 

Fetor  of  Breath 287,  307,  350,  529 

Fevers  of  Children 167 

Fissured  Tongue 186,    517 

Flagg's  Devitalizing  Mixture I79 

Foul  and  Fetid  Indolent  Ulcers 304 

Fracture  of  Alveolar  Process 54 

of  Jaw 61 

Fungous  Growths  and  Suppurating  Surfaces 69,    407 

Fungous  Growths  of  Pulp 69 

GALVANO-CAUTERY 99 
Gangrene  of   Mouth    (Cancrum   Orisj  .  .  58,  168,  278,  287,  307, 

354,  355,  493- 

Garretson's  Devitalizing  Mixture i79 

Germicide  Mouth  Wash 529 

Gingivitis 56,   58,  413 

Glycerite  of  Borate  of  Sodium 516 

Glyceritum  Sodii  Boratis 516 

Glycerole  of  Thymol  Preparation 528 

Gutta  Percha  Solution 411 

HARE-LIP 62 

Harlan's  Devitalizing  Mixtures 180 

Harris,  C.  A.,  Mouth  Wash 502 

Hectic  Fever 33 

Hemorrhage  from  Extraction  of  Teeth 48,.  199,  297,  376 

Hemorrhage  from  Lancing  Gums 376 

Hemorrhage  from  Constitutional  Vice 527 

Herpes  Zoster  of  Mouth  and  Gums 76 

Hypercemia 18 

Hypercementosis 71 

Hypersensitive  Dentine  (See  Sensitive  Dentine)     70 

Hypertrophy  of  Gums 64 

of  Processes    71 

of  Tonsils 199 

Hypnotic 304,  306 

IMPACTED  Tooth 60 

Incompatibilitv' 100 

Indigestion 463 

Indolent  Ulcers  of  Mouth 16S 

Infantile  Bilious  Diarrhoea 422,  457,  458,  485 

Mucous  Diarrhoea 422,   457,  458,  485 

Infantile  Paralysis  during  Dentition 74 


666         INDEX  TO  DISEASES  AND  DENTAL  FORMULARY. 


PAGE 

Inflamed  and  Ulcerated  Gums  ....    217,  250,  251,  413,  479,  482,  502,  544 

Inflamed  Fauces  and  Throat 168,  491 

Mucous  Membrane  and  Gums,   164,  199,  217,  218,  250,  251,  268,  272 
383,  406,  413,  479,  482,  489,  491,  502,  544. 

Inflammation     18 

of  Gums  after  Extraction  of  Teeth .    250,  251,  482,  489 

of  Mouth,   Syphilitic 58,  194,  489 

with  Special  Reference  to  the  Mucous  Membrane  of  the  Mouth  .     18 

Inflammatory  Fever 33 

Inhalation  in  Syphilitic  Ulcerations 194 

Injections,  Stimulant  and  Antiseptic 194 

Internal  Astringent  in  Hemorrhagic  Affections  and  Dental  Hemor- 
rhage     199 

Iodoform,  Deodorizing  of 399 

lodol.  Topical  Application 402 

Irritation 19 

of  Teething  and  Gums 46,  335 

of  Pulp  of  Tooth 68 

Ischasmia     .   .      19 

Itching  of  Inflamed  Surfaces 433 

of  the  Skin 194,  443 

KIRK'S  Devitalizing  Mixture 179 
Method  of  Bleaching  Teeth 471,  518 

LEAD  Poisoning 55 
Local  Anaesthetics,  184,  221,  247,  248,  264,  291,  292,  304,  305,  314 

334,  335,  336,  341,  378,  425,  522,  533,  538- 

Loose  Teeth  and  Inflamed  Gums 217 

Lotion  for  Soft  and  Spongy  Gums,  and  Loose  Teeth 217 

MALIGNANT  Ulcerations 58,  179 
Malignant  Tumors 59 

Medicated  Filling  Material 206 

Mercurial  Stomatitis 55,  212,  247,  268,  307,  317,  407,  415,  493 

Micro-organisms,  Effects  of 35 

Mild  Detergent  Gargle , 502,  517 

Mouth  Wash,  Chapin  A.  Harris 502 

Washes 186,  194,  217,  420,  435,  438,  497,  502 

Mucous  Patches  of  Mouth 507 

NASAL  Polypus 62 
Nausea  from  Wearing  Dentures 331,    336 

Necrosed  Teeth 74,  271 

Necrosis  of  Alveolar  Process 54 

Necrosis  of  the  Jaws 60 

Nerve  Paste 530 

Nervous  Cases 264 

Neuralgia,  221,  222,  273,  292,  304,  305,  334,  380,  400,  425,  446,  484,  505,  523 

from  Dental  Disturbance    380,  505 

in  Superficial  Nerves 274 

Neuralgic  Affections  of  the  Teeth 222,  273,  292,  304,  313,  314 

Odontalgia 351 

New  Remedies,  a  List  of  their  Action  and  Posology 558 


INDEX  TO  DISEASES  AND  DENTAL  FORMULARY.         567 


OBTUNDING  Mixtures,    Local   Anaesthetics  (See  Local  Anaes- 
thetics)   242,  248,  334,  335,  336,  435 

Odontalgia,   194,  195,   218,  221,  222,  247,  248,  250,  292,  304,  312,  314 
331,  334,  335,  336,  345,  380,  399,  425,  433. 

Odontomes 72 

Offensive  Breath 415,  493 

Ointment  of  Iodoform  and  Eucalyptus 400 

Organic  Defects  of  Structure 72 

Osseous  Tumors  of  the  Jaws 204 

Ossification  of  Pulp 70 

Oxychloride  of  Zinc  Preparations 206,  547 

Oxyphosphate  of  Zinc  Preparations 206,  547 

PAIN  following  Extraction  of  Teeth  ....     48,  195,  247,  292,  314,  433 
following  Separation  of  Teeth 287 

of  Difficult  Dentition 334 

Parasitic  Skin  Diseases 214 

Periodontitis  or  Pericementitis  ....    48,  167,  222,  407,  482,  489,  505,  515 

Perspiration  of  Hands,  etc 209,  407 

Phagedenic  and  Sloughing  Ulcers 415 

Phenol  Sodique  Preparations 193 

Phosphor  Necrosis 54 

Pierce's  Devitalizing  Mixture 179 

Plethora 18 

Poisons  and  Antidotes 113 

Pulpitis 69,  304,  314,  345,  382 

as  a  Capping  in 400 

Pulpless  Teeth 399,  400,  437,  470 

Pulveris  Effervescentes 514 

Putrescent  Pulps  .  369,  399,  400,  402,  407,  415,  437,  463,  470,  471,  493,  498 
Pyorrhoea  Alveolaris  (See  Formulae  under  Alveolar  Pyorrhoea)  ...  65 
Pyrosis 278 


Q 


UININE,  Disturbance  of  Nervous  System  from 262 


RECESSION  of  Gums 73 
Relaxation  of  Uvula 199 

Relaxed  Condition  of  Mucous  Membrane  of  Mouth  and  Gums  496 

Remove  Rust  on  Instruments 347 

Rheumatic  Pains,  Bruises,  etc 222 

Riggs'  Disease  (See  Alveolar  Pyorrhoea). 

Ringworm 277 

Robinson  Remedy 192 

Root  Canals  of  Abscessed  Teeth 369,  402,  415 

SALIVARY  Calculus,  after  Removal  of 217,  479 
Salivation 55 

Sandarach  Solution  or  Varnish 510 

Scrofula 59 

Scorbutic  Gums 168,  201 

Scurvy 55 

Sensitive  Dentine 70,  217,  247,  334,  335,  336,  514,  539 

Sensitiveness  after  Removal  of  Salivary  Calculus 217 

Shellac  Solution  or  Varnish 512 

Skin  Diseases 194,  195 

Sloughing  and  Ill-conditioned  Ulcers 203 

Sloughing  and  Ulceration  from  topical  application  of  Arsenious  Acid  178 


568         INDEX  TO  DISEASES  AND  DENTAL  FORMULARY. 


Soft  and  Spongy  Gums 193,  217 

Softened  Dentine . 319,  554 

Sore  Throat 184 

Sore  Mouth  of  Nursing  Women 184 

Sterilized  Instruments 247 

Stimulant  and  Antiseptic  Mouth  Wash  and  Lotion  .  .  .  .193,  194,  208,  247 

294,  438. 

and  Antiseptic  Injection 194,  209 

and  Anodyne  Lotion 292,  457 

Stomatitis 56,  57,  58,  335,  354,  529 

Stomatitis  of  Dentition 184 

Strength,  to  Support  the 278 

Styptic    413 

Superficial  Inflammation 247 

Suppurating  Pulps  of  Teeth  (See  Putrescent  Pulps)  369,  407,  463,  470,  471 

493,  498. 

Wounds 194 

Suppuration   ; 29 

to  Hasten 293 

Suppurative  Gingivitis 56 

Syphilitic  Teeth 72 

Ulceration  of  Mucous  Membrane  of  Mouth 58,  194 

TEETH  deficient  in  Lime  Salts 283,  285 
Teething  of  Children 335 

Thrush    63 

To  make  Solutions  of  Cocaine 80,  334 

To  render  the  Hands  Aseptic 347,  469 

Tonic  to  Support  Strength 278 

Tonsillitis 199 

Topical  Applications 402 

Trigeminal  Neuralgia 222 

Truman's  Devitalizing  Mixture 175 

Tumors  of  Gums 400 

of  Jaws 59,  204,  400 

ULCERATED  Gums  and  Mucous  Membrane  .  201,  212,  217,  250,  251 
_,  .  317,  354,  407,  489,  548- 

Ulceration 57,  64 

Ulceration  and  Abrasion  of  Mouth 212 

Ulceration  of  Mouth  and  Throat 217,  268,  272,  354,  493,  497,  548 

Ulcerous  Stomatitis    .  .  57,  201,  212,  217,  268,  317,  369,  406,  489,  493,  548 
Ulcers  of  Mouth    ....  57,  203,  217,  268,  317,  369,  415,  489,  493,  497,  548 

over  Carious  Bone 204 

Syphilitic     57^  489 

Ulitis  (See  Inflammation  of  Gums,  etc.) 56,  58 

Unerupted  Impacted  Tooth 60 

VAN  WOERT'S  Method  of  treating  Abscessed  Teeth 471 
Varnishes,  Dental 402 

Shellac     512 

Sandarach 512 

Venereal  Sore  Mouth  and  Throat 395 

Vomiting  and  Painful  Digestion  of  Teething  Children 278,  314 

WARTS,  Condylomata,  etc 209,  395 
Wash  after  Extraction  of  Teeth 317 

Wounds  and  Ulcers 194,  347,  397,  419,  427 


GENERAL  INDEX. 


ABBREVIATIONS,  82. 
Abies  Canadensis,  478. 

Abnormal  Dentition,  46. 

Sensibility  of  Dentine,  70. 
Abrasion  of  Teeth,  71. 
Abscess,  32. 
Abscess,  Alveolar,  50. 

of  Antrum,  51. 
Abscess,  Maxillary,  53. 
Absolute  Alcohol,  245. 
Absorbents,  150. 

Absorption  of  Alveolar  Process,  73. 
Acacia,  164. 
Acetate  of  Alumina,  251. 

of  Ammonia  Solution,  252. 

of  Lead,  480. 

of  Morphine,  429. 
Acetanilide,  165. 
Acetic  Acid,  167. 
Acids,  Organic,  129. 
Acids,  Inorganic,  129. 
Acidum  Aceticum,  167. 

Arseniosum,  168. 

Benzoicum,  181. 

Boricum,  184. 

Carbolicum,  186. 

Chromicum,  195. 

Cresyhcum,  197. 

Gallicum,  197. 
Acidum  Hydrobromicum,  200. 

Hydrochloricum,  200. 

Muriaticum,  200. 

Nitricum,  202. 

Nitricum  Dilutum,  202. 

Phosphoricum,  203. 

Salicylicum,  206. 

Sulphuricum,  209. 

Sulphuricum  Aromaticum,  210. 

Sulphurosum,  213. 

Tannicum,  214. 

Tartaricum,  218. 

Trichloroaceticum,  530. 
Aconite,  219. 

Aconitine,  Duquesnel's,  219. 
Aconitum,  219. 
Action  of  Medicines,  17. 
Acute  Inflammation  of  Dental 
Pulp,  69. 


Administration  of  Anaesthetics,  226. 
After-pains  of  Tooth-extraction,  48, 

195,  247,  292,  314,  433. 
^ther,  222. 
Alcohol,  245. 

Alkalies  and  Alkaline  Earths,  129. 
Alkaloids,  160. 
Aloe — Aloes,  248. 
Alteratives,  143. 
Alpha-oxynaphthoic  Acid,  437. 
Alum,  249. 
Alumen,  249. 

Exsiccatum,  250. 
Aluminse  Acetas,  251. 

et  Ammoniae  Sulphas,  250. 
Aluminii  et  Potassi  Sulphas,  250. 

Chloridum,  298. 

Sulphis,  252. 
Alveolar  Abscess,  50. 

about  to  Point  Externally,  51. 
Alveolar  Pyorrhoea,  65,  186. 
Alveolar  Ulceration,  52. 
American  Hellebore,  540. 
Ammonia,  252. 
Ammonia  Alum,  250. 

Aromatic  Spirits  of,  253. 

Water,  253. 
Ammonii  Bromidum,  279. 
Ammonii  Carbonas,  255. 

Chloridum,  256. 

Valerianas,  256. 
Ammonium,  252. 
Amyl  Nitris,  259. 
Amylene,  257. 
Amylene  Hydrate,  257. 
Anaemia,  18. 
Anaesthetics,  131. 

Administration  of,  etc.,  226. 

Mixture,  366. 
Analgesics,  150. 
Aniline,  261. 
Animal  Charcoal,  294. 
Anodynes,  150. 
Antacids,  144. 
Antemetics,  151. 
Anthelmintics,  149. 
Anthemis,  260. 
Antliridrotics,   151. 

569 


570 


GENERAL   INDEX. 


Antifebrin,  165. 

Antikamnia,  262. 

Antilithics,  144. 

Antiperiodics,   151. 

Antipyretics,  151. 

Antipyrine,  262. 

Antiseptic   Mixtures,    Dr.    Black's, 

'  195,  357- 
Antiseptic    and    Styptic    Cotton 

Wool,  265. 
Antiseptics,  151. 
Antiseptics,  Forms  of,  151. 
Antiseptics  in  Dental  Practice,  549. 
Antiseptics,  Incompatible,  557. 
Antispasmodics,  132. 
Antrum,  Disease  of,  51. 
Aphthae,  63. 

Apothecaries'  Weight,  85. 
Approximate  Measurements,  83. 
Aqua  Acidi  Carbolici,  189. 
Aqua  Ammonia,  253. 

Camphora,  290. 

Chlori,  307. 

Cinnamomi,  317. 

Creasoti,  343. 

Destillata,  265. 

Fortis,  202. 
Aralia  Spinosa,  541. 
Argenti  Nitras,  265. 
Aristol,  269. 
Aromatic  Bitters,  154. 

Spirits  of  Ammonia,  252. 
Aromatic  Sulphuric  Acid,  209. 
Arnica,  271. 
Arsenic,  Tests  for,  180. 
Arsenious  Acid,  168. 
Aseptol,  190. 
Astringents,  133. 
Artificial  Respiration,  235. 
Atropinae  Sulphas,  272. 
Atropine,  272. 
Aurum  Terchloridum,  274. 
Avoirdupois  Weight,  85. 

BACTERIA,  35,  552. 
Baths,  160. 

Belladonnae  FoHa,  275. 
Belladonnae  Rddix,  275. 
Benzoate  of  Lithium,  416. 
Benzoated  Lard,  181. 
Benzoic  Acid,  181. 
Benzoic  Sulphide  of  Sodium,  276. 
Benzoyl-pseudo-tropein,  533. 
Bert's    Method    of   Administering 

Anaesthetics,  232. 
Best  Twenty- five  Drugs,  112. 
Bicarbonate  of  Potassium,  484. 
of  Sodium,  513. 


Bichloride  of  Mercury,  387. 
Bichloride  of   Mercury,    Test  for, 

390- 
Bichloride  of  Methylene,  425. 
Biniodide  of  Mercury,  394. 
Bismuthi  Subnitras,  276. 
Bleaching  Discolored  Teeth,  75. 
Blenorrhetics,  142. 
Bloodletting,  General  and  Local,  93. 
Blue  Stone,  352. 

Mass,  393. 

Vitriol,  352. 
Bonwell's  Anaesthetic  Method,  242. 
Boric  Acid,  184. 

Lint,  185. 

Ointment,  185. 
Borate  of  Sodium,  515. 
Borax,  515. 
Boricine,  516. 
Boro-glyceride,  185. 
Bromides,  279. 
Bromide  of  Ammonium,  279. 

of  Calcium,  279. 

of  Lithium,  280. 

of  Sodium,  280. 

of  Camphor,  292. 

of  Ethyl,  363. 

of  Potassium,  485. 
Bromol,  281. 
Bromo-Phenol,  281. 
Brucine,  445. 

Burnett's  Disinfecting  Fluid,  543. 
Butyl-Chloral  Hydrate,  351. 

CADMII  Sulphas,  281. 
Calcii  Bromidum,  279. 
Calcii  Hypophosphis,  282. 
Calcii  Lithium,  279. 
Calcii  Phosphas  Praecipitatus,  476. 
Calcined  Magnesia,  420. 
Calcium,  284. 
Calendula,  283. 
Calisaya  Bark,  315. 
Calomel,  391. 
Calx,  284. 

Chlorata,  286. 
Campho-Phenique,  287. 
Camphoid,  291. 
Camphor,  289. 

Liniment,  290. 

Water,  290. 
Camphora,  289. 

Monobromata,  292. 
Camphorated  Tincture  of  Opium, 

457- 
Cantharidal  Collodion,  339. 
Cajuput  Oil,  451. 
Capsicum,  293. 


GENERAL   INDEX. 


571 


Carbo  Animalis  Purificatus,  294 

Ligni,  295. 
Carbolate  of  Camphor,  193. 
Carbolate  of  Cocaine,  473. 
Carbolate  of  Soda,  512. 
Carbolate   of  Sodium,  512. 
Carbolated  Cosmoline,  538. 
Carbolated  Camphor,  291. 
Carbolic  Acid,   186. 

Ointment,   189. 

Water,   189. 
Carbolic  Acid  Synthetic,  192. 
Carbolized  Cosmoline,  538. 
Carbon  compounds,  129. 
Carbonate  ot  Ammonium,  255. 

of  Lime,  347. 

of  Lithium,  416. 
Caries,  Dental,  77. 
Carminatives,  154. 
Carvacrol,  295. 
Cassia  Bark,  317. 
Cassia  Oil,  303. 
Cataplasms,  160. 
Catechu,  297. 
Cathartics,  137. 
Causes  of  Inflammation,  21. 
Caustic  Potassa,  483. 
Caustics,  147,   154. 
Cauterants,  147,   155. 
Cautery,  Actual  and  Potential,  147. 
Cayenne  Pepper,  293. 
Cerates,  162. 
Chalk  Mixture,  348. 
Chalk,  Prepared,  347. 
Chamomile,  260. 
Characteristic    Indications    of   the 

Tongue,  78. 
Chemical  Bleaching  of  Teeth,  75. 
Chinoline,  297. 
Chloral,  300. 

Hydras,  300. 
Chloral- Phenol,  303. 
Chloralamide,  305. 
Chloralum,  29S. 
Chlorate  of  Potassa  Troches,  448 

of  Potassium,  487. 
Chloride  of  Aluminium,  298. 
Chloride  of  Ammonium,  256. 

of  Ethyl,  360. 

of  Iron,  374. 

of  Lime,  286. 

of  Methyl,   299. 

of  Magnesium,  299. 

of  Zinc,   542. 

of  Zinc  Solution,  543. 

of  Tin,  299. 
Chlorinated     Lime  —  Chloride     of 
Lime,  286. 


Soda,  414. 
Chlorine,  306. 

Water,  307. 
Chlorinium,  306. 
Chloroform,  307. 

Chloroform-Cocaine  Narcosis,  312. 
Chloroform-Morphia  Narcosis,  312. 
Chloroformum,  307. 

Purifactum,  308. 
Chloro-Percha,  411. 
Chromic  Acid,  195. 
Chronic  Inflammation,  34. 
Chronic    Inflammation    of   Dental 

Pulp,  69. 
Cinchona  Flava,  Pallida  and  Rubra, 

315- 
Cinnabar,  394. 
Cinnamomum,  317. 
Cinnamon,  317. 

Oil,  318. 

Water,  318. 
Citrate  of  Lithium,  416. 
Citroleine  dentifrice,  351. 
Classification    of    Medicinal    Sub- 
stances,  130. 
Cleft  Palate,  62. 
Clinical  Thermometer,  124. 
Clysters,  161. 
Cobalt,  181. 
Cocaine,  319. 

Dangers  of,  332. 
Cocaine  Hydrochlorate,  321. 

Oleate,  321. 

Citrate,  321. 

Hydrobromate,  321. 

-Chloroform  Mixture,  312. 

-Chloroform  Narcosis,  312. 

Incompatibles,  333. 

Poisoning,  Treatment  of,  332. 
Cocainum  Phenylicum,  336. 
Cod-liver  Oil,  453. 
Colchicum,  336. 

Cold  as  a  Local  Anaesthetic,  239. 
Collodion,  337. 
CoUodium,  337. 

cum  Cantharide,  339. 

Flexile,  338. 

lodidum,  339. 
Collyria,  160. 

Compound    Syrup    of  the    Phos- 
phates, 476. 
Compound  Tincture  of  Iodine,  404. 
Coloring  Agents,  150. 
Colorless  Tincture  of  Iodine,  404. 
Condy's  Fluid,  492. 
Confections,  160. 
Conium,  340. 
Constringents,  155. 


572 


GENERAL   INDEX. 


Convulsions  of  Dentition,  46. 

Diluted  Solution  of  Subacetate  of 

Corrosive  Chloride  of  Mercury,  387. 

Lead,  481. 

Sublimate,  387. 

Dimethyloxyquinizine,  262. 

Coryl,  341. 

Discutients,  155. 

Cosmoline,  537. 

Disinfectants,  156. 

Counter-irritants,  155. 

Disinfecting  Instruments,  555. 

Creasote,  342. 

Dislocation  of  Lower  Jaw,  61. 

Ointment,  344. 

Distilled  Water,  265. 

Water,  343. 

Dithymol  Diodide  or  Biniodide,  269. 

Solidified,  343. 

Diuretics,  141. 

Creasotum,  342. 

Doses  of  Medicines,  Table  of,  102, 

Creolin,  346. 

Dover's  Powder,  456. 

Cresol,  197.                   / 

Drastics,   139. 

Cresylic  Acid,  197. 

Dried  Alum,  250. 

Creta  Prasparata,  347. 

Croton-Chloral  Hydrate,  351. 

T^CCRITICS,  130. 

JH^     Edentulous  Neuralgia,  72. 

Crystallin,  340. 

Crystallin  Varnish,  340. 

Effervescing  Powders,  514. 

Cupping,  94. 

Electricity  for    Relieving    Pain  of 

Cupri  Sulphas,  352. 

Extraction  of  Teeth,  94,  241. 

Methods  of  Applying,  241. 

T'^ANGERS  of  Anaesthesia,  224. 
J_y     Deadly  Nightshade,  275. 

as    a    Therapeutic    Means    in 

Treatment  of  Disease,  94. 

Decimal    System    of   Weights 

Electrolysis,  98. 

and  Measures,  86. 

Electrolysis  for    sensitive  Dentine 

Decoction  of  White  Oak  Bark,  500. 

and  Periodontitis,  98. 

Decoctions,  161. 

Electro-Magnetism    for  Extraction 

Decoctum  Quercus  Albae,  500. 

of  Teeth,  241. 

Definition  of  Subjects  Materia  Med- 

Electrozone,  354. 

ica  and  Therapeutics,  17. 

Electuaries,  160. 

of  Conditions  Associated  with 

Elementary  Substances,  Table  of, 

Distubances  of  Nutrition,  18. 

125. 

of  various  Classes  of  Remedial 

Elixir  of  Vitriol,  209. 

Agents,  130. 

of  Vitriol  and  Tannin,  216. 

Demulcents,  148. 

Emetics,  135. 

Dental  Caries,  77. 

Emmenagogues,  142. 

Exostosis,  71. 

Emollients,  156. 

Materia  Medica  and  Therapeu- 

Emulsions, 161. 

tics,  164. 

Enemata,  139,  161. 

Periostitis,  48. 

Endermic  Method,  91. 

Pulp,  Disease  of,  68. 

Epispastics,  146. 

Dentifrices,  317. 

Epithelioma,  64. 

Dentigerous  Cyst,  59. 

Epsom  Salts,  422. 

Deodorized  Tincture  of  Opium,  457. 

Epulis,  64. 

Deodorizers,  155. 

Equivalents,  88. 

Dermatol,  278. 

Ergot,  355. 

Desiccatives,  155. 

Erosion  of  Teeth,  73. 

Detergents,  155. 

Errhines,  156. 

Devitalizing  Pulps  of  Teeth,  174. 

Eruption  of  the  Teeth,  560. 

Dialysed  Iron,  373. 

Escharotics,  147,  156. 

Diaphoretics,  140. 

Essential  Oils,  355. 

Diaphtherine,  458. 

Ether,  222. 

Diarrhoea  of  Dentition,  46. 

Ethidene  Dichloridum,  359. 

Diarrhoea,  Infantile  Bilious,  422. 

Ethyl  Chloride-Mono-Chlor  Ethane, 

Diarrhoea,  Infantile  Mucous,  422. 

360. 

Dichloride  of  Ethidene,  359. 

Ethyl  Bromidum,  363. 

Diluents,  155. 

Eucalyptol,  367. 

Dilute  Acetic  Acid,  167. 

Eucalyptus,  367. 

GENERAL   INDEX. 


573 


Eugenic  Acid,  452. 

of  Gallic  Acid,  199. 

Eugenol,  452. 

of  Tannic  Acid,  216. 

Eugenol-acetamid,  370. 

Glycerites,  161. 

Europhen,  370. 

Glyceritum  Acidi  Carbolici,  189. 

Evacuants,   157. 

Acidi  Gallici,  199. 

Excitants,  157. 

Acidi  Tannici,  216. 

Exostosis,  Dental,  71. 

Sodii  Boratis,  516. 

Expectorants,  156. 

Gingivitis,  56,  58. 

Extraction  of  Teeth,  Pain  from 

,  48. 

Glacial  Acetic  Acid,  168. 

Extracts,  161. 

Glyceroborate  of  Calcium,  383. 

Extractum  Gelsemii  Fluidum, 

379- 

of  Sodium,  383. 

Krameriae,  412. 

Glycerole  of  Thymol,  528,  529. 

Exudation,  28. 

Glycozone,  383. 
Granulation,  29. 

IL'ACIAL  Neuralgia  (See   Index 

Green  Iodide  of  Mercur}',  393. 

X"^      to  Dental  Diseases,  etc^ 

Gum  Arabic,  164. 

Facial  Paralysis,  62. 

Guaiacol,  345. 

Febrifuges,  157. 

Gutta  Percha,  410. 

Ferri  Chloridum,  374. 

Ferri  Valerianas,  536. 

TT^MATINICS,  143. 
JTJ.     Hsemetics,  130. 

Ferrum,  372. 

Dialysatum,  373. 

Haemostatics,  157. 

Reductum,  374. 

Hamamelis,  385. 

Fever  of  Inflammation,  33. 

Hands,    To    Render    White    and 

Fillebrown's  Method  of  Administer- 

Soft, 414. 

ing  Ether,  234. 

Hare  Lip,  62. 

Fineness  of  Powder,  84. 

Harlan's  Method  of  Treating  Al- 

Follicular Ulceration,  63, 

veolar  Pyorrhcea,  468. 

Fomentations,  161. 

Hall's  (Marshall)  Ready  Method  in 

Formaline,  376. 

Asphyxia,  237. 

Forms  of  Antiseptics  for  Use, 

152. 

Hectic  Fever,  33. 

Forms  of  Medicinal  Substances, 

160. 

Hemorrhage  Following  the  Extrac- 

Fracture of  Alveolar  Process,  54. 

tion  of  Teeth,  48,  216,  376. 

Fracture  of  Lower  Jaw,  61. 

Hemlock,  340. 

French  Decimal  System  of  Weights 

Herbst's  Obtundent,  328. 

and  Measures,  86. 

Herpes  Zoster  of  Mouth  and  Gums, 

Fused  Potassa,  483. 

76. 

Fungous  Growth  of  Pulp,  69. 

Hill's  Stopping,  411. 

Fumigations,  161. 

Hoffman's  Anodyne,  223. 

Honey  of  Borate  of  Sodium,  185, 

/^ALLIC  Acid,  197. 
Vjr    Galls,  197. 

516. 

Howard's  Method  of  Artificial  Res- 

Galvano-Cautery, 99. 

piration  and    Resuscitation, 

Gangrene,  36. 

238. 

Gargles,  161. 

Hirudo,  93. 

Galvanism,  97. 

Hyderabad  Commission  on  Chloro- 

Gaultheria, 377. 

form,  309. 

Gelsemium,  378. 

Hydrarg>'ri     Chloridum     Corrosi- 

Germicides,  157. 

vum,  387. 

Glacial  Acetic  Acid,  168. 

Chloridum  Mite,  391. 

Glacial  Phosphoric  Acid,  204. 

Hydrargyrum,  386. 

Gleditschine,  520. 

cum  Creta,  393. 

Glycerin,  380. 

lodidum  Viride,  393. 

Glj'cerinum,  380. 

lodidum  Rubnmi,  394. 

Boracis,  516. 

Sulphidum  Rubnnn,  394. 

Pepsini,  462. 

Hydragogues,  137. 

Glycerite  of  Borate  of  Sodium, 

516. 

Hydrate  of  Amylene,  257. 

of  Carbolic  Acid,  189. 

of  Chloral,  300. 

574 


GENERAL  INDEX. 


Hydrate  of  Potash,  483. 
Hydrochlorate  of  Ammonia,  256. 

of  Morphine,  429. 
Hydrochloric  Acid,  200. 
Hydrobromic  Acid,  200. 

Ether,  363. 
Hydrogen  Dioxide,  464. 

Peroxide,  464. 
Hydronaphthol,  437. 
Hyperasmia,  18. 
Hypercementosis,  71. 
Hypersensitive  Dentine,  70. 
Hypersthenics,  157. 
Hypertrophy  of  Alveolar    Pro- 
cesses, 71. 

of  Gums,  64. 
Hypnotics,  130,  157,  306. 
Hypodermic  Method,  91. 
Hypophosphites,  475. 
Hypophosphite  of  Lime,  282. 

of  Quinine,  504. 

of  Sodium,  476. 

IMPACTED  TOOTH,  60. 
Important  Points  in  Diagnos- 
ing Affections  of  the  Mouth, 
46.  _ 
Incompatible  Antiseptics,  557. 
Incompatibility,  100. 
Infantile   Paralysis    during    Denti- 
tion, 74. 
Inflammation  with   special    Refer- 
ence to   the  Mucous   Mem- 
brane of  the  Mouth,  18. 
Inflammation,  Symptoms  of,  20,  25. 
Causes  of,  21. 
Terminations  of,  36. 
Treatment  of,  37. 
of  Peridental  Membrane,  48. 
of  Dental  Pulp,  69. 
of  Mucous   Membrane  of  the 
Mouth,  Syphilitic,  58. 
Inhalents,  161. 
Injections,  161. 
Infusions,  161. 
Infusum  Capsici,  293. 
Ingluvin,  464. 

Inorganic  Materia  Medica,  129. 
Iodide  of  Potassium,  403. 

of  Zinc,  545. 
Iodine,  402. 

Tri-chloride,  406,  407. 
lodophenacetin,  408. 
lodophenin,  409. 
Iodized  Collodion,  339. 
Iodoform,  395. 

Vapor,  Use  of,  397. 
lodoformum,  395. 


lodol,  400. 

lodum,  402. 

Iridis  Rhizome,  409. 

Iron  and  Preparations,  372. 

Irritants,   145. 

Irritation,  19. 

of  Dental  Pulp,  68. 

of  Teething,  46. 
Ischaemia,  19. 

Isobutyl-ortho-cresol-iodide,  370. 
Isonandra  Gutta,  410. 
Issues  and  Setons,  148. 

JABORANDI,  477. 
Jamaica  Dogwood,  479. 
Japanese  Camphor,  424. 

KALIUM-NATRIUM,  485. 
Kandol,  411. 
Kino,  415. 
Kirk's  Bleaching  Method,  471. 
Krameria,  412. 
Kresolum,  413. 

LABARR AGUE'S  Solution, 
414. 
Lacmus,  417. 
Lacto-Phosphate  of  Lime  Syrup, 

285. 
Lanolin,  414. 
Laudanum,  457. 
Laughing  Gas,  438. 
Laxatives,  139,  157. 
Lead  Poisoning,  55. 

Water,  481. 
Leeches,  93. 
Lenitives,  148. 
Leopard's  Bane,  271. 
Lime,  284. 

Liniment,  285. 

Water,  285. 
Liniments,  161. 
Linimentum  Calcis,  285. 

Camphorse,  290. 

Saponis,  290. 

Terebinthinas,  527. 
Liquefied  Nitrous  Oxide,  440. 
Liquor  Ammonii  Acetatis,  254. 

Calcis,  285. 

Ferri  Perchloridi,  374. 

Ferri  Subsulphatis,  374. 

Gutta  Percha,  374. 

Plumbi     Subacetatis    Dilutus, 
481. 

Potassii  Arsenitis,  172. 

Sodae  Chloratse,  414. 

Potassii  Permanganatis,  492. 
Liquor  Zinci  Chloridi,  543. 


GENERAL  INDEX. 


575 


Listerian  Method,  153. 

Mixtures,  162. 

Listerine,  1S3. 

Monobromated  Camphor,  292. 

Lithium,  416. 

Mono-Chlor-Ethane,  360. 

Lithii  Benzoas,  416. 

Monsel's  Solution  and  Powder,  374. 

Lithii  Bromidium,  280, 

Morphina,  428. 

Lithii  Carbonas,  416. 

Morphinae  Acetas,  429. 

Lithii  Citras,  416. 

Hydrochloras  or  Murias,  429. 

Lithii  Salicylas,  416. 

Sulphas,  430. 

Lithontriptics,  145. 

Morphine,  428. 

Litmus,  417. 

Narcosis,  312. 

Local  Anaesthesia,  239. 

Muriate  of  Ammonia,  256. 

Bloodletting,  93. 

of  Morphine,  429. 

Loretin,  418. 

Muriatic  Acid,  200. 

Lotions,  161. 

Myrrh,  433. 

Lunar  Caustic,  265. 

Myrrha,  433. 

Lysol,  418. 

Myrtle  Oil,  435. 
Myrtol,  435. 

■y/TAGNESIA,  420. 

.  .VI     Magnesii  Chloridum,  2 

99. 

IVT  APHTHALIN,  436. 
1  >l      NapelHne,  219. 

Sulphas,  422. 

Marigold,  283. 

Naphthalene,  436. 

Marshall  Hall's  Ready  Method 

,237. 

Naphtol,  436. 

Matico,  423. 

Narcotics,  130. 

Maxillary  Abscess,  53. 

Nasal  Polypus,  62. 

May  Apple,  482. 

Natural  Distribution  of  Remedies, 

Measurement    of    Medicinal 

Sub- 

129. 

stances,  83. 

Nausea  from   Impression    Taking, 

Measuring  Liquids  by  Drops, 

84. 

291. 

Meadow  Saffron,  336. 

Nauseants,  135. 

Medicated   Oxiphosphate    of 

Zinc 

Necrosed  Teeth,  74. 

fillings,  206. 

Necrosis  of  Alveolar  Process,  54. 

Menthol,  428. 

of  Jaw,  60. 

Mel  Boracis,  516. 

Nekton's     Method    of    Resuscita- 

Sodii Boracis,  185. 

tion,  235. 

Mercury,  386. 

Nervines,  158. 

with  Chalk,  393. 

Neuralgia,  Edentulous,  72. 

Bichloride  of,  387. 

Neurotics,  130. 

Mercurial  Ointment,  393. 

New  Remedies.     A  List  of.  Their 

Poisoning,  55. 

action  and  Posology,  558. 

Stomatitis,  55. 

Nitrate  of  Ammonia,  439. 

Mercuric  Chloride,  387. 

of  Potassium,  490. 

Mercurous  Chloride,  387. 

of  Silver,  265. 

Meta-iodo-ortho-oxyquinoline 

and 

Nitre,  490. 

Sulphonic  Acid,  418. 

Nitric  Acid,  202. 

Methyl  Chloride,  299. 

Nitric  Oxide,  439. 

Methyl  Ether,  427. 

Nitrite  of  Amyl,  259. 

Methyl-Ethylic  Ether,  427. 

Nitrous  Oxide,  438. 

Methyl  Violet,  495. 

Nitrous  Oxide,  Action  and  Admin- 

Methylene, 425. 

istration  of,  441,  443. 

Methylene-blue,  261. 

Nitrous  Powders,  490. 

Metric    System    of    Weights 

and 

Non-metals,  129. 

Measures,  86. 

Nutritives,  158. 

Microcidin,  427. 

Nux  Vomica,  445. 

Micro-Organisms,  Effects  of,  35. 

Mild  Chloride  of  Mercury,  391 
Mistura  Cretae,  348. 

/^BTUNDING  Mixtures,  Use  of, 
V^            242. 

Mixed  Chloroform   Morphia 

Nar- 

Odontones,  72. 

cosis,  312. 

Oil  of  Cassia,  318. 

576 


GENERAL  INDEX. 


Oil  of  Cajuput,  451. 

T)AIN    after    the    Extraction    of 
JL           Teeth,  48,  195,  247,  292,  314, 

of  Camphor,  291. 

of  Cinnamon,  318. 

433- 

of  Cloves,  451. 

Passive  Hypersemia,  18. 

of  Eucalyptus,  367. 

Papain  or  Papaiva,  458. 

of  Gaultheria,  377. 

Paraacetphenitidine,  472. 

of  Peppermint,  428. 

Paralysis,  Infantile,  74. 

of  Pyrethrum,  495. 

Paraldehyde,  459. 

of  Sanitas,  526,  527. 

Paregoric  EUxir,  457. 

of  Sweet  Almonds,  450. 

Pellitory,  495. 

of  Turpentine,  525. 

Peppermint  Camphor,  424. 

of  Vitriol,  209. 

Pepsin,  462. 

Oils,  Essential,  355. 

Pepsinum,  462. 

Ointment  of  Carbolic  Acid,  189. 

Saccharatum,  463. 

of  Creasote,  344. 

Percentage  Solution,  Tables  for,  80. 

of  Galls,  199. 

Perchloride  of  Iron,  374. 

of  Tannic  Acid,  217. 

Pericementitis,  48. 

of  Vaseline,  338. 

Pental,  460. 

of  Veratrine,  539. 

Periodontitis,  48. 

Ointments,  162. 

Permanganate  of  Potassium,  491. 

Oleate  of  Aluminum,  449. 

Peroxide  of  Hydrogen,  464. 

of  Arsenic,  449. 

Peroxide  of  Hydrogen,  Test  for,  467. 

of  Bismuth,  449. 

Peroxide  of  Sodium,  469. 

of  Cadmium,  450. 

Peruvian  Bark,  315. 

of  Cocaine,  321. 

Petrolatum,  537. 

of  Copper,  449. 

Petroleum  Ointment,  537. 

of  Lead,  446. 

Phenacetine,  472. 

of  Mercury,  447. 

Phenate  of  Cocaine,  473. 

of  Nickel,  450. 

Phenate  of  Sodium,  512. 

of  Silver,  450. 

Phenic  Acid,  186. 

of  Zinc,  448. 

Phenol,  t86. 

Oleates,  Medicinal,  162,  446. 

Phenol-Camphor,  291,  304. 

Oleum  Amygdalae  Dulcis,  450. 

Phenol  Sodique,  193,  512,  513. 

Cajuputi,  451. 

Phenosalyl,  477. 

Camphorae,  291. 

Phenyl-Acetamide,  165. 

Caryophilli,  451. 

Phenyl  Ether  of  Salicylic  Acid,  509. 

Cinnamomi,  318. 

Phenylic  Alcohol,  186. 

Eucalypti,  367. 

Phosphate  of  Lime,  476. 

Gaultheriae,  377. 

of  Sodium,  476. 

Morrhu^,  453. 

Phosphates,  475. 

Sanitas,  526. 

Phosphites,  475. 

Terebinthin^,  525. 

Phosphorus,  475.  _ 

Opium,  454. 

Phosphor  Necrosis,  54. 

Organic  Defects  of  Structure,  72. 

Phosphoric  Acid,  203. 

Organic  Materia  Medica,  129. 

in  the  Anhydrous  State,  204. 

Orris  Rhizome,  409. 

Pills,  162. 

Root,  409. 

Pilocarpus,  477. 

Ossification  of  Dental  Pulp,  70. 

Pinus  Canadensis,  478. 

Oxide  of  Potassium,  483. 

Piscidia  Erythrina,  479. 

of  Zinc,  546. 

Pix  Canadensis,  478. 

Oxyphosphate  of  Zinc  Filling  Ma- 

Plasters, 162. 

terial,  206. 

Plethora,  18. 

of  Zinc  Filling  Medicated,  206. 

Plumbi  Acetas,  480. 

Oxychloride  of   Zinc   Filling    Ma- 

Podophyllum, 482. 

terial,  544. 

Poisons,  113. 

Oxyquinaseptol,  458. 

Symptoms  and  Antidotes  for, 

Acid,  Mineral,  113. 

Aconite,  114. 

GENERAL   INDEX. 


577 


Alkalies,  114. 

Antimony,  114. 

Arsenious  Acid,  114. 

Argenti  Nitras,  114. 
Atropine,  115. 

Belladonna,  115. 

Cannabis  Indica,  115. 

Cantharides,  115. 

Carbolic  Acid,  115. 

Chloral,  116. 

Chlorine  Water,  116. 

Chloroform,   116. 

Cocaine,  332. 

Conium,  116 

Copper,  Sulphate  of,  117. 

Corrosive  Sublimate,  117. 

Creasote,   115,  343. 

Croton  Oil,  117. 

Digitahs,  117. 

Hydrocyanic  Acid,  117. 

Hyoscyamus,  118. 

Iodine,  118. 

Lead  Salts,  118. 

Mercury,   118. 

Morphine,  119. 

Nux  Vomica,  119. 

Opium,  119. 

Oxalic  Acid,  119. 

Phosphorus,  119. 

Potash  and  Soda  Salts,  119. 

Silver,  Nitrate  of,  119. 

Stramonium,  120. 

Strychnine,   120. 

TolDacco,   120. 

Zinc  Salts,  120. 
Poke  Root,  540. 
Posological  Tables,  102. 
Potassa  Alum,  250. 

Caustica,  483. 

Cum  Calce,  483. 
Potassii  Bicarbonas,  484. 
Potassii  Bromidum,  485. 

Chloras,  487. 

lodidum,  403. 

Nitras,  490. 

Permanganas,  491.      . 
Potassium  and  Sodium  Compound, 

485. 

Poultices,  162. 

Pulpitis,  69. 

Powdered  Subsulphate  of  Iron,  374, 

Precipitated  Chalk,  347. 

Phosphate  of  Lime,  476. 

Prepared  Chalk,  347. 

Preventive  Measures  against  Dan- 
gers of  Anaesthesia,  234. 

Prickly  Ash,  541. 


Prince's  Method  of  Treating  Alve- 
olar Abscess,  467. 
Protectives,  156. 
Protiodide  of  Mercury,  393. 
Protoxide  of  Nitrogen,  438. 
Prunus  Virginiana,  493. 
Pulse,  the,  120. 

Variations  in  Frequency  of,  121. 
Pulvis  Ferri  Subsulphatis,  374. 

Ipecac  et  opii.,  456 
Purgatives,  139,  158. 
Purified  Animal  Charcoal,  294. 
Pus,  30. 
Pyoktanin,  494. 
Pyorrhoea,  Alveolar,  65. 
Pyrethrum,  495. 
Pyrozone,  496. 

QUERCUS,  Alba,  500. 
Quicksilver,  386. 
Quillaia  Bark,  501. 
Quillaia  Saponaria,  501. 
Quininse,  315,  502. 

Hypophosphis,  504. 
Sulphas,  315,  502. 
Quinine,  315,  502. 
Quinoline,  297. 

RAPID  Breathing  as  a  Pain  Ob- 
tunder,  242. 

Refrigerants,  158. 
Recession  of  Gums,  73. 
Red  Sulphuret  of  Mercury,  394. 
Reduced  Iron,  374. 
Remedies,  Natural  Distribution  of, 

129. 
Resolvents,  159. 
Resorcin,  505. 

Respiration  at  Various  Stages,  123. 
Restoratives,   159. 
Resuscitation,  Methods  of,  235. 
Rhatany,  412. 
Rheum,  507. 
Rhigolene,  508. 
Rhubarb,  507. 
Rigg's  Disease,  65. 
Robinson  Remedy,  192. 
Rubefacients,  145. 
Rules  for  Administering  Anaesthet- 
ics, 226. 

for  Regulating  Doses,  89. 

SACCHARATED  Pepsin,  463- 
Sal  Ammoniac,  256. 
Salicylic  Acid,  206. 
Salicyl  Resorcin  Ketone,  506. 
Salicylate  of  Lithium,  416. 
Salicylate  of  Sodium,  517. 


578 


GENERAL   INDEX. 


Salipyrine,  208. 

Salivation,  55. 

Salol,  509. 

Saltpetre,  490. 

Sandaraca,  510. 

Sandarach,  510. 

Sanitas,  526. 

Scarifications,  94. 

Scurv'v,  55. 

Scrofula,  59. 

Sedatives,  135. 

Sensitive  Dentine,  70. 

Serpentaria,  510. 

Sesquicarbonate  of  Sodium,  513. 

Setons  and  Issues,  92. 

Shellac,  511. 

Sialagogues,  159. 

Soap  Liniment,  290. 

Sodae  Phenas,  512. 

Sodii  Bicarbonas,  513. 

Boras,  515. 

Bromidum,  280. 
Sodii  Hypophosphis,  476. 

Pyrophosphas,  476. 

Phosphas,  476. 

Salicylas,  517. 

Sulphis,  518. 
Sodium  Peroxide,  469. 
Sodium  Silico-Fluoride,  519. 
Solubility  of  Chemicals  in   Water 

and  Alcohol,  126. 
Solution  of  Acetate  of  Ammonia, 

254- 

of  Chlorinated  Soda,  414. 

of  Chloride  of  Zinc,  543. 

of  Gutta  Percha,  411. 

of    Permanganate     of    Potas- 
sium, 491. 

of  Subsulphate  of  Iron,  374. 
Soporifics.  130. 
S.  Am.  Soap  Tree  Bark,  501. 
Spastics,  135. 
Spirit  of  Camphor,  290. 

of  Chloroform,  312. 

of  Cinnamon,  318. 

of  Nitrous  Ether,  224. 

of  Mindererus,  254. 
Spinants,  135. 
Spiritus     Ammoniae     Aromaticus, 

253- 
Spiritus  vEtheris  Compositus,  222. 

Athens  Nitrosi,  223. 

Camphorse,  290. 

Chloroformi,  312. 

Cinnamomi,  318, 
Stannum  Chloridum,  299. 
Stenocarpine,  520. 
Sterilizing  Instruments,  555. 


Stimulants,  134. 
Stomachics,  134. 
Stomatitis,  56. 

Gangrenous,  58. 

Ulcerous,  57. 

Mercurial,  55. 

Syphilitic,  58. 
Strophanthin,  521. 
Strophanthus,  521. 
Strychnine,  445. 
Strychninae  Sulphas,  445. 
Styptic  Colloid,  216. 

Cotton,  216,  265. 
Styptics,  159. 

Subnitrate  of  Bismuth,  276. 
Subsulphate  of  Iron,  374. 
Sugar  of  Lead,  480. 
Sudorifics,  140. 
Sulfonol,  522. 
Sulphate  of  Atropine,  272, 

of  Cadmium,  281. 

of  Copper,  352. 

of  Magnesium,  422. 

of  Morphine,  430. 

of  Quinine,  315,  502. 

of  Strychnine,  445. 

of  Zinc,  547. 

of  Aluminium,  252. 
Sulphite  of  Soda,  518. 
Sulpho-Carbolates     of     Zinc,    So- 
dium,     Potassium,     Magne- 
sium, Calcium  and  Quinine, 
190. 
Sulpho-Carbolic  Acid,  189. 
Sulphophenol,  189. 
Sulfonal,  522. 
Sulphonal,  522. 
Sulphuric  Acid,  209. 

Ether,  222. 
Sulphurous  Acid,  213. 
Suppositories,  163. 
Suppurants,  147. 
Suppurating  Teeth,  353. 
Suppuration,  29. 

Sylvester's    Method  of  Resuscita- 
tion, 236. 
Symptoms  of  Inflammation,  25. 
Synopsis  of  Treatment  of    Affec- 
tions of  the  Mouth,  46. 
Synthetic  Carbolic  Acid,  192. 
Syphilitic     Inflammations     of    the 
Mouth,  58,  197. 

Teeth,  72. 

Ulcers,  197. 
Syrup  of  Lacto-Phosphate  of  Lime, 

285,  475- 
Syrups,  163. 


GENERAL   INDEX. 


579 


Syrupus    Calcii    Lacto-Phosphatis, 

285,  475- 

Hypophosphitum,  476. 


TABLE  of  Doses  of  Medicines, 
102. 
of  Equivalents,  88. 
Tables  of  Percentage  Solutions,  80. 
Tannic  Acid,  214. 
Tartaric  Acid,  218. 
Tartrate  of  Chinoline,  297. 
Terchloride  of  Gold,  274. 

of  Phenol,  524. 
Terebinthina,  525. 
Terebinthene,    Terpine,    Terpinol, 

Terbene,  526. 
Teriodide  of  Formyl,  395. 
Terminations  of  Inflammation,  36. 
Test  Papers  for  Dentists,  558. 
Tests  for  Arsenic,  180. 
Test  for  Cocaine,  333. 
Test  for  Peroxide  of  Hydrogen,  467. 
Tetra-iodo-ethylene-diodoform,  400 
Tetraiodopyrrol,  400. 
Thermometers,  123. 
Thierch's  Method  of  Morphia  Nar- 
cosis, 312. 
Thrush,  63. 
Thymacetin,  530. 
Thymol,  528. 
Tinctura  Aconiti,  220. 

Arnica,  271. 

Calendula,  283. 

Capsici,  293. 

Eucalypti,  367. 

Gelsemii,  37S. 

lodi,  404. 

lodi  Composita,  404. 

Kino,  416. 

Krameriae,  412. 

Myrrhse,  434. 

Opii,  457. 

Opii  Camphorata,  457. 

Opii  Deodorata,  457. 

Pyrethri,  495. 

Tinctura  Strophanthi,  522. 

Veratri  Viridis,  540. 
Tinctures,  163. 
Tonics,  132. 
Topical  Remedies,  91. 
Treatment  of  Dangerous  Symptoms 
of  Anaesthesia,  235. 

of  Inflammation,  37. 
Trichloride  of  Iodine,  407. 
Tri-Brom-Phenol,  2S1. 
Trichlorphenol,  532. 
Trichloroacetic  Acid,  530. 


Tricresole,  532. 
Trikresole,  532. 
Tri-Methyl  Ethylene,  460. 
Troches  of  Chlorate  of  Potassium, 

488. 
Tropacocaine,  533. 
Tropacocaine-Benzoyl-pseudo-tro- 

pein,  533. 
Troy  Weight,  85. 
Tumor  of  Jaws,  Malignant  Form  of, 

59- 
of  Upper  Jaws,  59. 
Turpentine,  525. 

Turpentine  as  a  Sterilizer  of  Instru- 
ments, etc.,  527. 

ULCERATION,  34. 
Ulceration,  Alveolar,  52. 
Ulcers  of  Mouth,  Syphilitic, 

57- 
Ulitis,  56. 

Unerupted  Impacted  Tooth,  60. 
Unguentum  Acidi  Carbolici,  189. 

Acidi  Tannici,  217. 

Boricum,  184. 

Creasoti,  344. 

Gallae,  199. 

Hydrargyri,  393. 

Veratrina,  539. 
Urethran,  535. 
Urethrane,  535. 

VALERIAN,  536. 
Valerianate  of  Ammonium, 
256,  536. 
Variation  in  the  Frequency  of  the 

Pulse,  121. 
Varnish,  Colored,  512. 
Aqueous,  512. 
Transparent,  512. 
Dental,  402. 
Vaselin,  537. 

Vaseline  Camphor  Ice,  538. 
Vaselone,  538. 
Veratrina,  539. 
Veratrine,  539. 
Veratrum  Viride,  540. 
Vermifuges,  149. 
Vermilion,    Eftects   of,   on   Mouth, 

394- 
Vesicants,  146,  159. 
Vienna  Paste,  483. 
Vinum  Opii,  456. 

Pepsini,  463. 
Virginia  Snake  Root,  510. 
Vitalized  Air,  233. 
Voltaic  Narcotism,  241. 


580 


GENERAL   INDEX. 


W ALB'S  Method  of  Using  Co- 
caine, 328. 

Obolinskie's  Method,  330. 

Raymond's  Method,  329. 
Weights  and  Measures,  85. 
White  Oak  Bark,  500. 
White  Oxide  of  Arsenic,  168. 
Wild  Cherry,  493. 
Windle's  Method  of  Administering 

Anaesthetics,  233. 
Wine  of  Opium,  456. 
Winter  Green,  377. 
Witch  Hazel,  385. 
Wood  Charcoal,  295. 


VANTHOXYLUM,  541. 

YELLOW  Cinchona,  315. 
Jasmine,  379. 
Yversen's  Method  of  Admin- 
istering Ansesthetics,  233. 

ZINCI  Chloridum,  542. 
lodidum,  545. 
Oxidum,  546. 
Sulphas,  547. 
Valerianas,  536. 


CATALOGUE 
No.  1. 


READ  "SPECIAL  NOTE"  BELOW. 

AUGUST,  1895. 


CATALOGUE 


Medical,  Dental, 

Pharmaceutical,  and  Scientific  Publications, 

WITH    A    SUBJECT    INDEX, 

OF  ALL  BOOKS  PUBLISHED  BY 

P.  BLAKISTON,  SON  &  CO. 

(Successors  to  Lindsay  &  Blakiston), 

PUBLISHERS,     IMPORTERS,    AND     BOOKSELLERS, 

IOI2  WALNUT  ST.,  PHILADELPHIA. 


SPECIAL   NOTE. 

The  prices  as  given  in  this  catalogue  are  absolutely  net,  no  discount  will 
be  allowed  retail  purchasers  under  any  consideration.  This  rule  has  been 
established  in  order  that  everyone  will  be  treated  alike,  a  general  reduction  in 
former  prices  having  been  made  to  meet  previous  retail  discounts.  Upon 
receipt  of  the  advertised  price  any  book  will  be  forwarded  by  mail  or  express, 
all  charges  prepaid. 

We  keep  a  large  stock  of  Miscellaneous  Books  relating  to  Medicine  and 
Allied  Sciences,  published  in  this  country  and  abroad.  Inquiries  in  regard  to 
prices,  date  of  edition,  etc.,  will  receive  prompt  attention. 


The  following:  Catalogues  sent  free  upon  application: — 

CATALOGUE  No.   1. — A  complete  list  of  the  titles  of  all  our  publications  on  Medicine, 

Dentistry,  Pharmacy,  and   Allied    Sciences,  with    Classified 

Index. 
CATALOGUE  No.   2. — Medical  Books.     Illustrated  with  portraits  of  prominent  authors 

and  figures  from  special  books. 
CATALOGUE  No.  3.— Pharmaceutical  Books. 
CATALOGUE  No.  4.— Books  on  Chemistry  and  Technology. 
CATALOGUE  No.   5.— Books  for  Nurses  and  Lay  Readers. 
CATALOGUE  No.  6. — Books  on  Dentistry  and  Books  used  by  Dental  Students. 
CATALOGUE  No.  7. — Books  on  Hygiene  and  Sanitary  Science;  Including  Water  and 

Milk  Analysis,  Microscopy,  Physical  Education,  Hospitals,  etc. 
SPECIAL  CIRCULARS.— Morris'  Anatomy  ;  Gould's  Medical  Dictionaries ;  Moullin's 

Surgery;  Books  on  the  Eye;  The  ?  Quiz  Compends?  Series, 

Visiting  Lists,  etc.     We  can  also  fiu-nish  sample  pages  of 

many  of  our  publications. 


P.  Blakiston,  Son  &  Co.s  publications  may  be  had  through  booksellers  in  all  the  princi- 
pal cities  of  the  United  States  and  Canada,  or  any  book  will  be  sent  by  them,  postpaid,  upon 
receipt  of  the  price.  They  will  forward  parcels  by  express,  C.  O.  D.,  upon  receiving  a  remittance 
of  25  per  cent,  of  the  amount  ordered.  Money  should  be  remitted  by  express  or  post  office 
money  order,  registered  letter,  or  bank  draft. 


THE  PRICES  OF  ALL  BOOKS  ARE  NET. 


CLASSIFIED  LIST,  WITH  PRICES, 

OF  ALL  BOOKS  PUBLISHED  BY 

P.  BLAKISTON,  SON  &  CO.,  PHILADELPHIA. 

When  the  price  is  not  given  below,  the  book  is  out  of  print  or  about  to  be  published. 
Cloth  binding,  unless  otherwise  specified.     For  full  descriptions  see  following  Catalogue. 


ANATOMY. 
Ballou.     Veterinary  Anat.      $0.80 

Campbell.     Dissector.         -    

Heath.    Practical.     7th  Ed.     4.25 
Holden.  Dissector.  Oil-cloth,  2.50 

Osteology.    -        -         S-^S 

Landmarks.     4th  Ed.    i.oo 

Macalister's  Text-Book.     -    5.00 
Marshall's   Phys.  and  Anat. 

Diagrams.  $40.00  and    60.00 

Morris.  Text  Book  of.  791  lUus. 

Clo  ,  6.00;  Sh.,  7.00;  Yf  Rus.,  8.00 
Potter.      Compend  of.       5th 

Ed.     133  Illustrations.  -  .80 

Wilson's  Anatomy,  nth  Ed.  5.00 

ANESTHETICS. 
Buxton.     Anaesthetics.   -  1.25 

Turnbull.     3d  Ed.  -         3-«> 

BRAIN  AND  INSANITY. 
Blackburn.     Autopsies.     -       1.25 
Gowers.      Diagnosis   of  Dis- 
eases of  the  Brain.     2d  Ed.      1.50 
Horsley.  Brain  and  S.  Cord.   2.50 

Hyslop.  Mental  Physiology.  

Lewis   (Bevan).    Mental 

Diseases.         -        -        -  5.00 

Mann's  Psychological  Med.  3.00 
Regis.  Mental  Medicine.  -  2.00 
Stearns.  Mental  Dis.  Illus.  2.75 
Tuke.  Dictionary  of  Psycho- 
logical Medicine.  2  Vols.  10.00 
Wood.     Brain  and  Overwork.     .40 

CHEMISTRY. 

See  Technological  Books.  Water. 
Allen.     Commercial    Organic 
Analysis.  2d  Ed.  Volume  I.  

Volume  II.  -         -         

Volume  III.     Part  I.   

Volume  III.     Part  II.  4.50 

Volume  III.  Part  III. 

Diabetic  Urine.         -       2.25 

Bartley.     Medical  and  Phar- 
maceutical.    3d  Ed.         -        2.75 

Bloxam's  Text-Book.  8th  Ed.  4.25 
Caldwell.       Qualitative    and 

Quantitative  Analysis.        -     1.50 
Clowes.    Qual.  Analysis.       -     i.oo 
Groves  and  Thorp.     Chemi- 
cal Technology.  Vol.  I.  Fuels  5.00 

Vol.11.     Lighting.      -     4.60 

Holland.    Urine,  Gastric  Con- 
tents, Poisons  and  Milk  Anal- 
ysis. 5th  Ed.        ... 
Leffmann's  Compend. 
Progressive  Exercises 

Milk  Analysis.     - 

MUter.     Pract.  and  Anal. 
Ramsay.      Inorganic.    Illus. 
Richter's  Inorganic.   4th  Ed. 

' —      Organic.     2d  Ed.  ,  ., 

Smith.      Electro-Chem.  Anal.  1.25 
Smith  and  Keller.     Experi 

ments.     2d  Ed.     Illus. 
Stammer.     Chem.  Problems, 
Sutton.     Volumetric  Anal. 
Symonds.      Manual  of. 
Trimble.     Analytical.      - 
Watts.     (Fowne's)  Inorg. 

(Fowne's)  Organ. 

W^oody.  Essentials  of  4th  Ed 

CHILDREN. 
Goodhart  and  Starr. 
Hale.     Care  of 
Hatfield.     Compend  of 
Meigs.      Infant   Feeding    and 

Milk  Analysis.  -  .5° 

Money.     Treatment  of    -  2.50 

Muskett.     Treatment  of  1.25 

Power.   Surgical  Diseases  of.  2.50 


I.oo 
.80 
I.oo 

1-25 

1.25 

4.00 
1-75 
4-50 


.60 
•  50 
4.50 
2.00 
1.50 
2.00 
2.00 


2.50 
•  SO 
.80 


Starr.  Digestive  Organs  of.  ^2.00 
Hygiene  of  the  Nursery,  i.oo 

CLINICAL  CHARTS. 
Griffiths.     Graphic.    Pads.        .50 
Temperature  Charts.    "  .50 

COMPENDS 
And  The  Quiz-Compends. 

Ballou.     Veterinary  Anat.  .80 

Brubaker's  Physiol.  7th  Ed.  .80 

Fox  and  Gould.     The  Eye.  .80 

Hall.     Pathology.     Illus.  .80 

— —  Nose  and  Ear.          -  .80 

Hatfield.     Children.          -  .80 

Horwitz.    Surgery.     5th  Ed.  .80 

Hughes.  Practice.  2  Pts.  Ea.  .80 

Landis.    Obstetrics.    5th  Ed.  .80 

Leff'mann's  Chemistry.  4th  Ed.  .80 

Mason.     Electricity.        -  .75 

Potter's   Anatomy,   5th  Ed.  .80 

Materia  Medica.  6th  Ed.  .80 

Stewart,  Pharmacy.  5th  Ed.  .80 

■Warren.     Dentistry.    2d  Ed.  .80 

Wells.     Gynsccology.      -  .80 

DEFORMITIES. 
Reeves.      Bodily  Deformities 
and  their  Treatment.     Illus.   1.75 
DENTISTRY. 
Barrett.     Dental  Surg.   -  i.oo 

Blodgett.  Dental  Pathology.  1.25 
Flagg.     Plastic  Filling.  -  4.00 

Fillebrown.  Op.  Dent.  Illus.  2,25 
Gorgas.  Dental  Medicine.  4.00 
Harris.     Principles  and  Prac.  6.00 

Dictionary  of     5th  Ed.  4.50 

Heath.     Dis.  of  Jaws.        -     4-5° 

Lectures  on  Jaws.  Bds.    .50 

Richardson.  Mech.  Dent.  400 
Sewell.  Dental  Surg.  -  2.00 
Taft.    Operative  Dentistry.       3.00 

,  Index  of  Dental  Lit.       2.00 

Talbot.  Irregularity  of  Teeth.  3.00 
Tomes.     Dental  Surgery.  4.00 

Dental  Anatomy.  3.50 

Warren's  Compend  of.    -  .80 

Dental    Prostheses   and 

Metallurgy.     Illus.        -  1.25 

White.    Mouth  and  Teeth.        .40 

DICTIONARIES. 
Cleveland's  Pocket  Medical.     .50 
Gould's  Illustrated  Dictionary 
of  Medicine,  Biology,  and  Al- 
lied Sciences,  etc.     Leather, 
Net,   Sio.oo;     Half    Russia, 
Thumb  Index,        -       Net,  12  00 
Gould's  Medical  Student's  Dic- 
tionary. J^  Lea.,  2.75;  J^Mor. 
Thumb  Index.     -        -        -     3-So 
Gould's    Pocket     Dictionary. 
12,000  medical  words.    Lea., 
I.oo:  Thumb  Index,       -         1.25 
Harris'  Dental.  Clo. 4.50;  Shp.s.50 
Longley's  Pronouncing.  .75 

Maxwell.  Terminologia  Med- 
ica Polyglotta.  -        -        3-00 
Treves.    German-English.        3.25 

EAR. 
Burnett.     Hearing,  etc.  .40 

Dalby.    Diseases  of.   4th  Ed.  2.50 
Hall.     Compend.        -      -  .80 

Hovell.     Treatise  on.  -     5  00 

Pritchard.     Diseases  of.  1.25 

ELECTRICITY. 
Bigelow.  Plain  Talks  on  Medi- 
cal Electricity.     43  Illus.         i.oo 
Mason's   Electricity  and    its 

Medical  and  Surgical  Uses.  _     .75 
Steavenson  &  Jones.  Medi- 
cal Electricity.     Illus.     -        


EYE. 
Arlt.     Diseases  of   -        -        $1.25 
Fick.     Handbook  of  Dis.  — ^ 

Fox  and  Gould.  Compend.  .80 
Gower's  Ophthalmoscopy.  4.00 
Harlan.     Eyesight.  -  .40 

Hartridge.  Refraction.  sthEd.  i.oo 

Ophthalmoscope.    -         1.25 

Hansen   and    Bell.    Clinical 

Ophthalmology.  120  Illus.  1.50 
Higgins.  Practical  Manual.  1.50 
Macnamara.  Diseases  of.  3.50 
Meyer.  Text-Book.  -  3.50 
Morton.  Refraction.  4th  Ed.  i.oo 
Phillips.  Spectacles  and  Eye- 
glasses. 47  Illus.  2d  Ed.  — — 
Swanzy's  Handbook.  4th  Ed.  2.50 

FEVERS. 
Collie,  On  Fevers.   -  i.co 

HEADACHES. 
Day.    Their  Treatment,  etc.     1.00 
HEALTH  AND  DOMESTIC 
MEDICINE. 
Bulkley.    The  Skin.        -  .40 

Burnett.     Hearing.         -  .40 

Cohen.  Throat  and  Voice.  .40 
Dulles.  Emergencies.  4th  Ed.  i.oo 
Harlan.     Eyesight.  -  .40 

Hartshorne.  Our  Homes.  .40 
Osgood.  Dangers  of  Winter.  .40 
Packard.    Sea  Air,  etc.  .40 

Richardson's  Long  Life.  .40 

Westland.     The  Wife  and 

Mother.         .        .        -  1.50 

White.  Mouth  and  Teeth.  .40 
■Wilson.  Summer  and  its  Dis.  .43 
Wood.     Overwork.         -  .40 

HEART. 
Sansom.     Diseases  of.       -       6.00 

HYGIENE. 
Canfield.  Hygiene  of  the  Sick- 

Room.      .        -        -        -        I.2S 
Coplin  and  Bevan.     Practi- 
cal Hygiene.     Illus.        -        3.25 
Fox.     Water,  Air,  Food.  3.50 

Kenwood.      Public     Health 

Laboratory  Guide.  -  2.00 
Lincoln.  School  Hygiene.  .40 
McNeill.  Epidemics  and  Iso- 
lation Hospitals.  -  -  3.50 
Parke's  (E.)  Hygiene.  8th  Ed.  4.50 
(L.C.),  Manual 


Elements  of  Health. 


2.50 

_ 1-25 

Starr.  Hygiene  of  the  Nursery,  i.oo 

Stevenson  and  Murphy.  A 

Treatise  on  Hygiene.     In  3 

Vols.     Circular        Vol.  1,     6.00 

upon  application.     Vol.  II,    6.00 

Vol.  Ill,   5.00 

■Wilson's  Handbook.   7th  Ed.  3.C0 

■Weyl.    Coal-Tar  Colors,  1.25 

JOURNALS,  Etc. 
Ophthalmic  Review.   12  Nos.  3.00 
New  Sydenham  Society's 

Publications,  each  year.     -    8.00 
KIDNEY  DISEASES. 
Ralfe.     Dis.  of  Kidney,  etc.     2.00 
Thornton.     Surg,  of  Kidney.  1.50 
Tyson.     Bright's   Disease 
and  Diabetes,  Illus. 

MASSAGE. 
Kleen  and  Hartwell.      - 
Murrell.     Massage,  sth  Ed. 
Ostrom.    Massage.  87  Illus. 
MATERIA  MEDICA 
Biddle.    13th  Ed.    Cloth, 

Bracken.     Materia  Med.  

Davis.     Essentials  of  Materia 
Med.  and  Pres.  Writing  of      1.50 


2.50 
2.25 

I.2S 

I.oo 
4.00 


ALL  PRICES  ARE  NET. 

CLASSIFIED  LIST  OF  P.  BLAKISTON,  SON  &>  CO:S  PUBLICATIONS. 


Gorgas.  Dental.  5th  Ed.  J4.r0 
Potter's  Compend  of.  5th  Ed.  .80 
Potter's  Handbook  of.    Fifth 

Ed.    Cloth,  4.00  ;  Sheep,  5.00 

Sayre.   Organic  Materia  Med. 

and  Pharmacognosy.        -  4.00 

White  &  Wilcox.  Mat.  Med., 

Pharmacy,       Pharmacology, 

and    Therapeutics.     2d   Ed. 

Enlarged.  Cloth,  2.75;  Sh.  3.25 
MEDICAL  JURISPRUDENCE. 
Mann.  Forensic  Med.  -  6.50 
Reese.  Medical  Jurisprudence 

&Toxicology,4th  Ed. 3.00;  Sh.  3.50 
MICROSCOPE. 
Beale.     How  to  Work  with.     6.50 

In  Medicine.         -  6.50 

Carpenter.     The  Microscope. 

7th  Ed.     800  lUus.  -        5.50 

Lee.  Vade  Mecum  of.  -  4.00 
MacDonald.     Examination  of 

Water  and  Air  by.  -  2.50 

Reeves.  Medical  Microscopy. 

Illustrated.        ...         2.50 
Wethered.     Medical  Micros- 
copy.    lUus.       ...     2.00 
MISCELLANEOUS. 
Black.     Micro-organisms.            .75 
Burnet.     Food  and  Dietaries.  1.50 
Davis.    Text-bookof  Biology.  3.00 
Duckworth.    On  Gout.       -    6.00 
Garrod.     Rheumatism,  etc.      5.00 
Gowers.    Dynamics  of  Life,     .75 
Haig.     Uric  Acid.         .        -    3.00 
Hare.     Mediastinal  Disease.    2.00 
Harris  and  Beale.  Consump- 
tion.       ....         

Henry.  Anaemia.  -  -  .50 
Hiltoni  Rest  and  Pain  -  2.50 
Leffmann.  Coal  Tar  Products.  1.25 
Powell.  Lungs,  etc.  -  -  4.00 
Treves.     Physical  Education.    .75 

NERVOUS  DISEASES,  Etc. 
Flower.   Atlas  of  Nerves.        2.50 
Gowers.    Manual  of.     2d  Ed. 

530  lUus.  Vol.  1,3.00  ;  Vol.  2,4.00 
Syphilis  and  the  Nerv- 
ous System.        ...      i.oo 

Diseases  of  Brain.  1.50 

Clinical  Lectures.  

Horsley.      Brain   and    Spinal 

Cord.  Illus.  ...  2.50 
Obersteiner.   Central  Nervous 

System.    ....  5.50 

Ormerod.  Manual  of.  -  i.oo 
Osier.     Cerebral  Palsies.  2.00 

Chorea.  -  -         2.00 

Page.     Injuries  of  Spine.  

Railway  Injuries.       -       2.25 

Thorburn.      Surgery    of    the 

Spinal  Cord.  ...  4.00 
Watson.     Concussions.  i.oo 

NURSING. 
CanReld.  Hygiene  of  the  Sick- 


125 
•75 


•75 
1-25 


Room 
Cullingworth.    Manual  of. 

Monthly   Nursing. 

Domville's  Manual.     7th  Ed. 
FuUerton.     Obst.  Nursing. 

Nursing   in   Abdominal 

Surg,  and  Dis.  of  Women,  1.50 

Humphrey.  iVIanual.  i3thEd.  i.oo 
Shawe.  District  Nursing.  i.oo 
Starr.  Hygieneof  the  Nursery,  i.oo 
Temperature  Charts.    -  .50 

Voswinkel.     Surg.  Nursing,    i.oo 

OBSTETRICS. 
Bar.  Antiseptic  Midwifery,  i.oo 
Cazeauxand  Tarnier.  Text- 
Book  of.  Colored  Plates.  4.50 
Davis.  Obstetrics.  Illus.  2.00 
Landis.  Compend.  sih  Ed.  .80 
Schultze.  Obstetric  Diagrams. 

20  Plates,  map  size.  Net,  26.00 
Strahan.  Extra-Uterine  Preg.  .75 
Winckel's  Text-book.  5.00 

PATHOLOGY  &  HISTOLOGY. 
Blackburn.     Autopsies.  1.25 

Blodgett.  Dental  Pathology  1.25 
Gilliatn.     Essentials  of.     -  .75 


Hall.  Compend.  lllus.  .  J0.80 
Stirling.  Histology.  2d  Ed.  2.00 
Virchow.     Post-mortems.  .75 

PHARMACV 
Beasley's  Receipt-Book.      .    2.00 
^—^  formulary.      -        -  2.00 

Coblentz.  Manual  of  Pharm.    3.50 
Proctor.     Practical  Pharm.      3.00 
Robinson.  Latin  Grammar  of.    1.75 
Sayre.    Organic  Materia  Med. 
and  Pharmacognosy.       -  4.00 

Scoville.     Compounding.         

Stewart's  Compend.  sth  Ed.  .80 
U.   S.   Pharmacopoeia.     7th 

Revision.  Cl.  2.50  ;  Sh.,  3.00 

Select  Tables  from  U.S.  P.       .25 

■White  and 'Wilcox.  Materia 

Medica  and  Phar.     2d  Ed.      2.75 

PHYSICAL  DIAGNOSIS. 

Tyson's  Manual.  2d  Ed.  Illus.  1.25 

•  PHYSIOLOGY. 
Brubaker's  Compend.     Illus- 
trated.    7th  Ed.       -        -  .80 
Kirkes'  New  13th  Ed.     (Au- 
thor's Ed.)  Cloth,  3.25;  Sh.,  4.00 
Landois'  Text-book.  845  Illus- 
trations. 2  Vols.       -           -      7.00 
Starling.     Elements  of.      -     i.oo 

Stirling.    Practical  Phys.         

Tyson's  Cell  Doctrine.       -       1.50 
Yeo's  Manual.  254  Illustrations 
6th  Ed.    Cloth,  2.50    Sheep,  3.00 
POISONS. 
Murrell.     Poisoning.         -        i.oo 
Reese.    Toxicology.     3d  Ed.   3.00 


•75 

1-25 

2.00 

7.00 

3.00 

.80 


•75 

3.00 

.40 

4.50 


Tanfler.     Memoranda  of. 

PRACTICE. 
Beale.     Slight  Ailments. 
Charteris,  Guide  to. 
Fagge's  Practice.    2  Vols. 
Fowler's  Dictionary  of. 
Hughes.  Compend.  2  Pts.  ea. 

Physicians'  Edition. 

I  Vol.  Morocco,  Gilt  edge.     2.25 

Roberts.  Text-book.  9th  Ed.  4.50 
Taylor's  Manual  of.     -  2.00 

PRESCRIPTION  BOOKS. 
Beasley's  3000  Prescriptions.   2.00 

Receipt  Book.        -  2.00 

Davis.     Materia  Medica  and 

Prescription  Writing.  -  1.50 
Pereira's  Pocket-book.  .75 

■Wythe's  Dose  and  Symptom 

Book.     17th  Ed.     - 
SKIN. 
Anderson's  Text-Book. 
Bulkley.    The  Skin. 
Crocker.    Dis.  of  Skin.    Illus. 
Van   Harlingen.     Diagnosis 

and  Treatment  of  Skin  Dis. 

3d  Ed.     Illus.  -        .        

STIMULANTS  &  NARCOTICS. 
Lizars.     On  Tobacco.      -  .40 

Parrish.     Inebriety.         -  i.oo 

SURGERY  AND  SURGICAL 

DISEASES. 
Caird  and  Cathcart.    Surg- 

geon's  Pocket-Book.  Lea.  2.50 
Dulles.  Emergencies.  -  i.oo 
Hacker.  Wounds.  -  .  .50 
Heath's  Minor.    loth  Ed.         1.25 

Diseases  of  Jaws.       -    4.50 

Lectures  on  Jaws.  .50 

Horwitz.  Compend.   5th  Ed.     .80 
Jacobson.     Operations  of.    -     3.00 
Macready  on  Ruptures        -     6.00 
Moullin.      Complete     Text- 
book.    2d   Ed.  by  Hamilton, 
600  Illustrations  and  Colored 
Plates.  Cl.  6.00;  Sh.    7.00 

Porter's  Surgeon's  Pocket- 
book.  -  -  Leather  2.00 
Smith.  Abdominal  Surg.  6.00 
Voswinkel.  Surg.  Nursing,  i.oo 
■Walsham.  Practical  Surg.  2.75 
Watson's  Amputations.  5.50 

TECHNOLOGICAL  BOOKS. 
Cameron.  Oils  &  Varnishes.    2.25 

Soap  and  Candles.         2.00 


4.00 


3°o 
4  00 

1-75 

1.25 

50 


Gardner.     Brewing,  etc.         J'-So 

Gardner.  Bleaching  and 
Dyeing.     -         -         .         .         1.50 

Groves  and  Thorp.  Chemi- 
cal Technology.  Vol.  I. 
Mills  on  Fuels.  -         Cl.  5.00 

Vol.  II.     Lighting. 
Vol.111.   Lighting  Contin'd. 

Overman.     Mineralogy.     . 

THERAPEUTICS. 
Allen,  Harlan,  Harte,  Van 
Harlingen.     Local  Thera. 
Biddle.     13th  Edition 
Field.  Cathartics  and  Emetics. 
Mays.     Therap.  Forces. 

Theine  ... 

Napheys'  Therapeutics.  Vol. 

1.     Medical  and  Disease  of 
Children.  .  Cloth,  4.00 

Vol.  2.  Surgery,  Gynaec. 

&  Obstet.  .  Cloth,  4.00 

Potter's  Compend.     5th  Ed.      .80 

,  Handbook  of.  4.00;  Sh.5.00 

^Varing's  Practical.    4th  Ed.  2.C0 
White    and    Wilcox.     Mat. 
Med.,  Pharmacy,  Pharmacol- 
ogy, and  Thera.     2d  Ed.        2.75 
THROAT  AND  NOSE. 
Cohen.     Throat  and  Voice.        .40 
Hall.     Nose  and  Throat.     -      2.50 

Nose  and  Ear.  .  .80 

Hutchinson.  Nose  &  Throat. —. 
Mackenzie.     Throat  Hospital 

Pharmacopoeia.  5th  Ed.  i.oo 
McBride.      Clinical  Manual, 

Colored  Plates.  2d  Ed.  -  6.00 
Murrell.  Bronchitis.  .  1.50 
Potter.  Stammering,  etc.  i.oo 
Woakes.  Post-Nasal  Catarrh,  i.oo 

TRANSACTIONS. 
Trans.  College  of  Physicians.  3.50 

Assoc.  Amer.  Phys.   3.50 

URINE  &  URINARY  ORGANS. 
Acton.     Repro.  Organs.  1.75 

Allen.     Diabetic  Urine.  2.25 

Beale.  Urin.  Deposits.  Plates.  2.00 
Holland.  The  Urine,  Milk  and 

Common  Poisons.  5th  Ed.  i.oo 
Legg.  On  Urine.  7th  Ed.  i.oo 
Marshall  and  Smith.  Urine,  i.oo 
Memminger.     Diagnosis   by 

the  Urine.  Illus.  -  -  i.oo 
Moullin.  The  Prostate.  .  1.50 
Thompson.  Urinary  Organs.   3.C0 

Calculous  Dis.  3d.  Ed.      .75 

Tyson.  Exam,  of  Urine.  1.25 
Van  Niiys.    Urine  Analysis,     i.oo 

VENEREAL  DISEASES. 
Cooper.  Syphilis.  2d  Ed.      .     5.00 
Gowers.      Syphilis  and    the 

Nervous  System.  .  .  i.oo 
Hill  and  Cooper's  Manual.  .75 
Jacobson.     Diseases   of  Male 

Organs.     Illustrated.        -       6.00 

VETERINARY. 

Armatage.     Vet.  Rememb.  i.oo 

Ballou.     Anat.  and  Phys.  .80 

Tuson.     Pharmacoposia.  2.25 

VISITING   LISTS. 
Lindsay  &  Blakiston's  Reg- 
ular Edition.  i.oo  to  2.25 

Perpetual  Ed.     1.25  to  1.50 

Monthly  Ed.         .75  to  i.oo 

Send  Jor  Circular, 

WATER. 

•Fox.     Water,  Air,  Food.  3  50 

Leffmann.    Examination  of.  1.25 

MacDonald.  Examination  of.  2.50 

WOMEN,  DISEASES  OF. 

By  ford  (H.  T.).     Manual.      

Byford(W.  H.).  Text-book.  2.00 
Diihrssen.     Gynecological 

Practice.  105  Illustrations.  1.50 
Lewers.  Dis.  of  Women.  2.ro 
Wells.     Compend.     Illus.  .80 

Winckel,  by  Parvin.    Manual 

of.     Illus.       Cloth  3.00  ;  Sh.  3  50 


iS^  BASED  ON  RECENT  MEDICAL  LITERATURE. 

Gould's  Medical  Dictionaries 

BY  GEORGE   M.  GOULD,  A.M.,  M.D., 

Ophthalmic  Surgeon  to  the  Philadelphia  Hospital,  Editor  of  "The  Medical  News." 


THE  STANDARD  MEDICAL  REFERENCE  BOOKS. 


The  Illustrated   Dictionary  of  Medicine, 
Biology,  and  Allied  Sciences. 

INCLUDING  THE  PRONUNCIATION,  ACCENTUATION,  DERIVATION,  AND  DEFINITION 
OF  THE  TERMS  USED  IN  MEDICINE  AND  THOSE  SCIENCES  COLLATERAL  TO  IT  : 
BIOLOGY    (zoology  AND   BOTANY),  CHEMISTRY,    DENTISTRY,    PHARMACOLOGY, 

MICROSCOPY,  ETC.     With  many  Useful  Tables  and  numerous  Fine  Illustra- 
tions.    Large,  Square  Octavo.     1633  pages. 
Full  Sheep,  or  Half  Dark-Green  Leather,  ^10.00;  with  Thumb  Index,  ^11.00 
Half  Russia,  Thumb  Index,  ^12.00 


The  Student's  Medical  Dictionary. 

INCLUDING  ALL  THE  WORDS  AND  PHRASES  GENERALLY  USED  IN  MEDICINE,  WITH 
THEIR  PROPER  PRONUNCIATION  AND  DEFINITIONS,  BASED  ON  RECENT  MEDI- 
CAL LITERATURE.  With  Tables  of  the  Bacilli,  Micrococci,  Leucomains, 
Ptomains,  etc.,  of  the  Arteries,  Muscles,  Nerves,  Ganglia,  and  Plexuses; 
Mineral  Springs  of  the  U.  S.,  Vital  Statistics,  etc.  Small  Octavo.  520 
pages.        Half  Dark  Leather,  ^2.75  ;  Half  Morocco,  Thumb  Index,  ^3.50 

"  We  know  of  but  one  true  way  to  test  the  value  of  a  dictionary,  and  that  is  to  use  it.  We 
have  used  the  volume  before  us,  as  much  as  opportunity  would  permit,  and  in  our  search  have 
never  suffered  disappointment.  The  definitions  are  lucid  and  concise,  and  are  framed  in  the 
terms  supplied  by  the  latest  authoritative  literature,  rather  than  by  purely  philological  method. 
Obsolete  words  are  omitted,  and  this,  has  made  the  dimensions  of  the  book  convenient  and  com- 
pact. In  making  a  dictionary,  the  author  confesses  that  he  has  found  out  the  labor  consists  in 
eliminating  the  useless,  rather  than  adding  the  superfluous.  The  value'  of  the  work  before  us 
is  increased  by  the  large  number  of  useful  reference  tables  in  anatomy,  ptomains,  micrococci, 
etc." — The  Physician  and  Surgeon,  Ann  Arbor. 


The  Pocket  Pronouncing  Medical  Lexicon. 

12,000  -WORDS  PRONOUNCED  AND  DEFINED. 

Double  the  Number  in  any  Other  Similar  Book.  Containing  all  the  Words, 
their  Definition  and  Pronunciation,  that  the  Student  generally  comes  in  con- 
tact with;  also  elaborate  Tables  of  the  Arteries,  Muscles,  Nerves,  Bacilli, 
etc.,  etc.;  a  Dose  List  in  both  English  and  Metric  Systems,  etc.,  arranged 
in  a  most  convenient  form  for  reference  and  memorizing.     Thin  64mo. 

Full  Limp  Leather,  Gilt  Edges,  ^i.oo;  Thumb  Index,  ^1.25 


These  books  may  be.,  ordered  through  any  bookseller,  or  upon  receipt  of 
price  the  publishers  will  deliver  free  to  the  purchaser's  address.  Full  descriptive 
circulars  and  sample  pages  sent  free  upon  application. 

40,000  COPIES  OF  GOULD'S  DICTIONARIES  HAVE  BEEN  SOLD. 

\*  The  Prices  of  all  Books  are  absolutely  Net. 


fi®"-  All  prices  are  net.     No  discount  can  be  allowed  retail  purchasers. 

P.  BLAKISTON,  SON  &  CO.'S 
JYJedical   and   |§cientific   publications, 

No.  IOI2  Walnut  St.,  Philadelphia. 


ACTON.  The  Functions  and  Disorders  of  the  Reproductive  Organs  in  Childhood, 
Youth,  Adult  Age  and  Advanced  Life,  considered  in  their  Physiological,  Social 
and  Moral  Relations.     By  Wm.  Acton,  m.d.,  m.r.c.s.    8th  Edition.     Cloth,  $1.75 

ALLEN,   HARLAN.   HARTE,  VAN   HARLINGEN.     Local   Therapeutics. 

A  Handbook  of  Local  Therapeutics,  being  a  practical  description  of  all  those 
agents  used  in  the  local  treatment  of  diseases  of  the  Eye,  Ear,  Nose,  Throat, 
Mouth,  Skin,  Vagina,  Rectum,  etc.,  such  as  Ointments,  Plasters,  Powders, 
Lotions,  Inhalations,  Suppositories,  Bougies,  Tampons,  and  the  proper  methods  of 
preparing  and  applying  them.  By  Harrison  Allen,  m.d.,  Laryngologist  to  the 
Rush  Hospital  for  Consumption ;  late  Surgeon  to  the  Philadelphia  and  St. 
Joseph's  Hospitals.  George  C.  Harlan,  m.d.,  late  Professor  of  Diseases  of  the 
Eye  in  the  Philadelphia  Polyclinic  and  College  for  Graduates  in  Medicine ; 
Surgeon  to  the  Wills  Eye  Hospital,  and  Eye  and  Ear  Department  of  the 
Pennsylvania  Hospital.  Richard  H.  Harte,  m.d..  Surgeon  to  the  Episcopal 
and  St.  Mary's  Hospital;  Ass't  Surg.  University  Hospital;  and  Arthur  Van 
Harlingen,  m.d..  Professor  of  Diseases  of  the  Skin  in  the  Philadelphia  Poly- 
clinic and  College  for  Graduates  in  Medicine  ;  late  Chnical  Lecturer  on  Derma- 
tology in  Jefferson  Medical  College  ;  Dermatologist  to  the  Howard  Hospital. 

In  One  Handsome  Compact  Volume.     Cloth,  13.00 
ALLEN.     Commercial  Organic  Analysis.     A  Treatise  on  the  Modes  of  Assaying 
the  Various  Organic  Chemicals  and  Products  employed  in  the  Arts,  Manufactures, 
Medicine,  etc.,  with  Concise  Methods  for  the  Detection  of  Impurities,  Adultera- 
tions, etc.     Second  Edition.    Revised  and  Enlarged.    By  Alfred  Allen,  f.c.s. 
Vol.  I.  Alcohols,  Ethers,  Vegetable  Acids,  Starch,  etc.  Out  of  P?'int. 

Vol.  II.  Fixed  Oils  and   Fats,  Hydrocarbons  and  Mineral  Oils,  Phenols  and 
their  Derivatives,  Coloring  Matters,  etc.  Oiii  of  Print. 

Vol.  Ill— Part  I.     Acid   Derivatives   of  Phenols,  Aromatic   Acids,  Tannins, 
Dyes,  and  Coloring  Matters.     8vo.  Oitt  of  Print. 

Vol.  Ill — Part  II.  The  Amines,  Pyridine  and  its  Hydrozines  and   Derivatives, 
The  Antipyretics,  etc.     Vegetable  Alkaloids,  Tea,  Coffee,  Cocoa,  etc.     8vo. 

Cloth,  $4.50 
Vol.  Ill— Part  III.  In  Press. 

Chemical  Analysis  of  Albuminous  and  Diabetic  Urine.   Illus.  Cloth,  $2.25 

ANDERSON.  A  Treatise  on  Skin  Diseases.  With  special  reference  to  Diagnosis 
and  Treatment,  and  including  an  Analysis  of  11,000  consecutive  cases.  By  T. 
McCall  Anderson,  m.d..  Professor  of  Clinical  Medicine,  University  of  Glasgow. 
With  several  Full-page  Plates,  two  of  which  are  Colored  Lithographs,  and  nu- 
merous Wood  Engravings.     Octavo.     650  pages.       Cloth,  $3.00;  Leather,  j?4. 00 

ARLT.  Diseases  of  the  Eye.  Clinical  Studies  on  Diseases  of  the  Eye.  Including  the 
Conjunctiva,  Cornea  and  Sclerotic,  Iris  and  Ciliar}'  Body.  By  Dr.  Ferd.  Ritter 
VON  Arlt,  University  of  Vienna.  Authorized  Translation  by  Lyman  Ware, 
M.D.,  Surgeon  to  the  Illinois  Charitable  Eye  and  Ear  Infirmary,  Chicago. 
Illustrated.     8vo.  Cloth.  $1.25 

ARMATAGE.  The  Veterinarian's  Pocket  Remembrancer :  being  Concise 
Directions  for  the  Treatment  of  Urgent  or  Rare  Cases,  embracing  Semeiology, 
Diagnosis,  Prognosis,  Surgery,  Treatment,  etc.  By  George  Armatage,  m.r.c.v.s. 
Second  Edition.     32mo.  Boards,  $1.00 

5' 


p.  BLAKISTON,  SON  <S-  CO:S 


BALLOTJ.  Veterinary  Anatomy  and  Physiology.  By  Wm.  R.  Ballou,  m.d.. 
Prof,  of  Equine  Anatomy,  New  York  College  of  Veterinary  Surgeons,  Physician 
to  Bellevue  Dispensary,  and  Lecturer  on  Genito-Urinary  Surgery,  New  York 
Polyclinic,  etc.  With  29  Graphic  Illustrations.  i2mo.  No.  12  ?  Quiz-Compend? 
Series.  Cloth,  .80.     Interleaved,  for  the  addition  of  Notes,  $1.25 

BAR.  Antiseptic  Midwifery.  The  Principles  of  Antiseptic  Methods  Applied  to 
Obstetric  Practice.  By  Dr.  Paul  Bar,  Obstetrician  to,  formerly  Interne  in,  the 
Maternity  Hospital,  Paris.  Authorized  Translation  by  Henry  D.  Fry,  m.d., 
with  an  Appendix  by  the  author.     Octavo.  Cloth,  $1.00 

BARRETT.  Dental  Surgery  for  General  Practitioners  and  Students  of  Medicine 
and  Dentistry.  Extraction  of  Teeth,  etc.  By  A.  W.  Barrett,  m.d.  Second 
Edition.     Illustrated      i2mo.  Cloth,  $1.00 

BARTLEY.  Medical  and  Pharmaceutical  Chemistry.  Third  Edition.  A  Text- 
book for  Medical  and  Pharmaceutical  Students.  By  E.  H.  Bartley,  m.d.,  Pro- 
fessor of  Chemistry  and  Toxicology  at  the  Long  Island  College  Hospital ;  Dean 
and  Professor  of  Chemistry,  Brooklyn  College  of  Pharmacy ;  President  of  the 
American  Society  of  Public  Analysts ;  Chief  Chemist,  Board  of  Health,  of 
Brooklyn,  N.  Y.  Revised  and  Enlarged.  With  Illustrations.  Glossary  and 
Complete  Index.     i2mo.     684  pages.  Cloth,  $2.75;  Leather,  ;^3. 25 

BEALE.  On  Slight  Ailments ;  their  Nature  and  Treatment.  By  Lionel  S.  Beale, 
M.D.,  F.R.S.,  Professor  of  Practice,  King's  Medical  College,  London.  Second 
Edition.     Enlarged  and  Illustrated.     8vo.  Cloth,  $1.25 

The  Use  of  the  Microscope  in  Practical  Medicine.  For  Students  and 
Practitioners,  with  full  directions  for  examining  the  various  secretions,  etc., 
in   the  Microscope.     Fourth  Edition.     500  Illustrations.     8vo.     Cloth,  $6.50 

How  to  Work  with  the  Microscope.  A  Complete  Manual  of  Microscopical 
Manipulation,  containing  a  full  description  of  many  new  processes  of 
investigation,  with  directions  for  examining  objects  under  the  highest 
powers,  and  for  taking  photographs  of  microscopic  objects.  Fifth  Edition. 
Containing  over  400  Illustrations,  many  of  them  colored.     8vo.    Cloth,  $6.50 

One  Hundred  Urinary  Deposits,  on  eight  sheets,  for  the  Hospital,  Labora- 
torj^  or  Surgery.     New  Edition.     4to.  Paper,  $2.00 

BEASLEY'S  Book  of  Prescriptions.  Containing  over  3100  Prescriptions,  collected 
from  the  Practice  of  the  most  Eminent  Physicians  and  Surgeons — English, 
French,  and  American ;  a  Compendious  History  of  the  Materia  Medica,  Lists  of 
the  Doses  of  all  Officinal  and  Established  Preparations,  and  an  Index  of  Diseases 
and  their  Remedies.     By  Henry  Beasley.     Seventh  Edition.  Cloth,  $2.00 

Druggists'  General  Receipt  Book.  Comprising  a  copious  Veterinary  Formu- 
lary ;  Recipes  in  Patent  and  Proprietary  Medicines,  Druggists'  Nostrums, 
etc.;  Perfumery  and  Cosmetics  ;  Beverages,  Dietetic  Articles  and  Condi- 
ments ;  Trade  Chemicals,  Scientific  Processes,  and  an  Appendix  of  Useful 
Tabled    Tenth  Edition.     Revised.  Just  Ready.     Cloth,  $2.00 

Pocket  Formulary  and  Synopsis  of  the  British  and  Foreign  Pharmacopoeias. 
Comprising  Standard  and  Approved  Formulae  for  the  Preparations  and 
Compounds  Employed  in  Medical  Practice.    Eleventh  Edition.    Cloth,  fc.oo 

RIDDLE'S  Materia  Medica  and  Therapeutics.  Including  Dose  List,  Dietary  for 
the  Sick,  Table  of  Parasites,  and  Memoranda  of  New  Remedies.  By  Prof. 
John  B.  Biddle,  m.d.,  Late  Prof,  of  Materia  Medica  in  Jefferson  Medical  College, 
Philadelphia.  Thirteenth  Edition,  thoroughly  revised  in  accordance  with  new 
U.  S.  P.,  by  Clement  Biddle,  m.d..  Assistant  Surgeon,  U.  S.  Navy.  With  64 
Illustrations  and  a  Clinical  Index.    Octavo.  Cloth,  $4.00 ;  Sheep,  $5.00 


MEDICAL  AND  SCIENTIFIC  PUBLICATIONS.  7 

BIGELOW.  Plain  Talks  on  Medical  Electricity  and  Batteries,  with  a  Thera- 
peutic Index  and  a  Glossary.  Prepared  for  Practitioners  and  Students  of  Medi- 
cine. By  Horatio  R.  Bigelow,  m.d.,  Fellow  of  the  British  Gynaecological 
Society ;  of  the  American  Electro-Therapeutic  Association ;  Member  American 
Medical  Association,  etc.    43  Illus.,  and  a  Glossary,    2d  Ed.     i2mo.     Cloth,  gi.oo 

BLACK.  Micro-Organisms.  The  Formation  of  Poisons.  A  Biological  study  of 
the  Germ  Theory  of  Disease.     By  G.  V.  Black,  m.d.,  d.d.s.  Cloth,  .75 

BLACKBURN.  Autopsies.  A  Manual  of  Autopsies,  Designed  for  the  use  of  Hos- 
pitals for  the  Insane  and  other  Public  Institutions.  By  I.  W.  Blackburn,  m.d.. 
Pathologist  to  the  Government  Hospital  for  the  Insane,  Washington,  D.  C.  With 
ten  Full-page  Plates  and  four  other  Illustrations.     i2mo.  Cloth,  $1.25 

BLODGETT'S  Dental  Pathology.  By  Albert  N.  Blodgett,  m.d..  Late  Prof,  of 
Pathology  and  Therapeutics,  Boston  Dental  Coll.    33  Illus.    i2mo.    Cloth,  $1.25 

BLOXAM.  Chemistry,  Inorganic  and  Organic.  With  Experiments.  By 
Charles  L.  Bloxam.  Edited  by  J.  M.  Thompson,  Professor  of  Chemistry  in 
King's  College,  London,  and  A.  G.  Bloxam,  Head  of  the  Chemistry  Depart- 
ment:, Goldsmiths'  Institute,  London.  Eighth  Edition.  Revised  and  Enlarged. 
281  Engravings,  20  of  which  are  new.     8vo.  Cloth,  $\.i^\  Leather,  t^.i^ 

BRACKEN.     Outlines  of  Materia  Medica  and  Pharmacology.     By  H.  M. 

Bracken,    Professor   of    Materia    Medica   and   Therapeutics   and   of  Clinical 
Medicine,  University  of  Minnesota.  In  Press. 

BRTJBAKER.  Physiology.  A  Compend  of  Physiology,  specially  adapted  for  the 
use  of  Students  and  Physicians.  By  A.  P.  Brubaker,  m.d..  Demonstrator  of 
Physiology  at  Jefferson  Medical  College,  Prof,  of  Physiology,  Penn'a  College  of 
Dental  Surgery,  Philadelphia.  Seventh  Edition.  Revised,  Enlarged,  and  Illus- 
trated.    No.  4,  f  Quiz- Compend  f  Series.    i2mo.      Cloth,  .80  ;  Interleaved,  $1.25 

BULKLEY.  The  Skin  in  Health  and  Disease,  By  L.  Duncan  Bulkley,  m.d., 
Attending  Physician  at  the  New  York  Hospital.     Illustrated.  Cloth,  .40 

BURNET.  Foods  and  Dietaries.  A  Manual  of  Clinical  Dietetics.  By  R.  W. 
Burnet,  m.d.,  m.r.c.p.,  Physician  to  the  Great  Northern  Central  Hospital. 
General  Contents — Diet  in  Derangements  of  the  Digestive,  Nervous,  and  Res- 
piratory Organs ;  in  Gout,  Rheumatism,  Anemia,  Fevers,  Obesity,  etc. ;  in  Dis- 
eases of  Children,  Alcoholism,  etc.  With  Appendix  on  Predigested  Foods  and 
Invalid  Cookery.  Full  directions  as  to  hours  of  taking  nourishment,  quantity, 
etc.,  are  given.     Second  Edition.     i2mo.  Cloth,  $1.50 

BURNETT.  Hearing,  and  How  to  Keep  It.  By  Chas.  H.  Burnett,  m.d.,  Prof, 
of  Diseases  of  the  Ear  at  the  Philadelphia  Polyclinic.     Illustrated.         Cloth.  .40 

BUXTON.  On  Anesthetics.  A  Manual.  By  Dudley  Wilmot  Buxton,  m.r.c.s., 
M.R.C.P.,  Ass't  to  Prof,  of  Med.,  and  Administrator  of  Anesthetics,  University 
College  Hospital,  London.     Second  Edition,  Enlarged  and  Illustrated.     i2mo. 

Cloth,  $1.2^ 

BYFORD.  Diseases  of  Women.  The  Practice  of  Medicine  and  Surgery,  as 
applied  to  the  Diseases  and  Accidents  Incident  to  Women.  By  W.  H.  Byford, 
A.M.,  M.D.,  Professor  of  Gynecology  in  Rush  Medical  College,  etc.,  and  Henry 
T.  Byford,  m.d..  Surgeon  to  the  Woman's  Hospital  of  Chicago;  Gynecologist 
to  St.  Luke's  Hospital;  President  Chicago  Gynaecological  Society,  etc.  Fourth 
Edition.    Revised.     306  Illustrations,  over  100  of  which  are   original.     Octavo. 

Cloth,  $2.00;  Leather,  $2.50 

BYFORD.  Manual  of  Gynecology.  A  Practical  Student's  Book.  By  Henry  T. 
Byford,  m.d..  Surgeon  to  Woman's  Hospital,  Chicago,  etc.  With  numerous 
Illustrations,  many  of  which  are  from  original  drawings.  Nearly  Ready. 


p.  BLAKISTON,  SON  <S-  CO:S 


CA.IIID  AND  CATHCART.  Surgical  Handbook.  By  F.  M.  Cairo,  f.r.c.s.,  and 
C.  W.  Cathcart,  f.r.c.s.  Fifth  Edition,  Revised.  i88  Illustrations.  i2mo. 
278  pages.  Full  Red  Morocco,  Gilt  Edges,  and  Round  Corners,  $2.50 

CALDWELL.  Chemical  Analysis.  Elements  of  Qualitative  and  Quantitative 
Chemical  Analysis.  By  G.  C.  Caldwell,  b.s.,  Ph.d.,  Professor  of  Agricultural 
and  Analytical  Chemistry  in  Cornell  University,  Ithaca,  New  York,  etc.  Third 
Edition.     Revised  and  Enlarged.     Octavo.  Cloth,  $1.50 

CAMERON.  Oils  and  Varnishes.  A  Practical  Handbook,  by  James  Cameron 
F.i.c.     With  Illustrations,  Formulas,  Tables,  etc.     i2mo.  Cloth,  ^2.25 

Soap  and  Candles.     A  New  Handbook   for  Manufacturers,  Chemists,  Ana- 
lysts, etc.     54  Illustrations.     i2mo.  Cloth,  $2.00 

CAMPBELL.  Outlines  for  Dissection.  To  be  Used  in  Connection  with  Morris's 
Anatomy.  By  W.  A.  Campbell,  m.d..  Demonstrator  of  Anatomy,  University 
of  Michigan.  Nearly  Ready. 

C  ANFIELD.  Hygiene  of  the  Sick-Room.  A  book  for  Nurses  and  others.  Being 
a  Brief  Consideration  of  Asepsis,  Antisepsis,  Disinfection,  Bacteriology,  Immun- 
ity, Heating  and  Ventilation,  and  kindred  subjects,  for  the  use  of  Nurses  and 
other  Intelligent  Women.  By  William  Buckingham  Canfield,  a.m.,  m.d., 
Lecturer  on  Clinical  Medicine  and  Chief  of  Chest  Clinic,  University  of  Mary- 
land, Physician  to  Bay  View  Hospital  and  Union  Protestant  Infirmary,  Balti- 
more.    i2mo.  Cloth,  $1.25 

CARPENTER.  The  Microscope  and  Its  Revelations.  By  W.  B.  Carpenter, 
M.D.,  f.r.s.  Seventh  Edition.  By  Rev.  Dr.  Dallinger,  F.  R.  s.  Revised  and 
Enlarged,  with  800  Illustrations  and  many  Lithographs.     Octavo,     iioo  Pages. 

Cloth,  $5.50 

CAZEAUX  and  TARNIER'S  Midwifery.    With  Appendix,  by  Mund6.    The 

Theory  and  Practice  of  Obstetrics,  including  the  Diseases  of  Pregnancy  and 
Parturition,  Obstetrical  Operations,  etc.  By  P.  Cazeaux.  Remodeled  and  re- 
arranged, with  revisions  and  additions,  by  S.  Tarnier.m.d.  Eighth  American, 
from  the  Eighth  French  and  First  Italian  Edition.  Edited  by  Robert  J.  Hess, 
M.D.,  Physician  to  the  Northern  Dispensary,  Phila.,  etc.,  with  an  Appendix  by 
Paul  F.  Munde,  m.d..  Professor  of  Gynaecology  at  the  New  York  Polyclinic. 
Illustrated  by  Chromo-Lithographs,  Lithographs,  and  other  Full-page  Plates 
and  numerous  Wood  Engravings.     8vo.  Cloth,  $4.50;  Full  Leather,  $5.50 

CHARTERIS.  Practice  of  Medicine.  The  Student's  Guide.  By  M.  Charteris, 
M.D.,  Professor  of  Therapeutics  and  Materia  Medica,  Glasgow  University,  etc. 
Sixth  Edition,  with  Therapeutical  Index  and  many  Illustrations.         Cloth,  $2.00 

CLEVELAND'S  Pocket  Medical  Dictionary.  By  C.  H.  CLEvatAND,  m.d.  Thirty- 
third  Edition.     Very  small  pocket  size.  Cloth,  .50;  Tucks  with  Pocket,  .75 

CLOWES  AND  COLEMAN.  Elementary  Qualitative  Analysis.  Adapted  for 
Use  in  the  Laboratories  of  Schools  and  Colleges.  By  Frank  Clowes,  d.Sc.. 
Professor  of  Chemistry,  University  College,  Nottingham,  and  J.  Bernard  Cole- 
man, Demonstrator  of  Chemistry,  Nottingham,  England.     lUus.        Cloth,  $1.00 

COBLENTZ.  Manual  of  Pharmacy.  A  Text-Book  for  Students.  By  Virgil 
CoBLENTZ,  A.M.,  PH.G.,  PH.D.,  Professor  of  Theory  and  Practice  of  Pharmacy, 
Director  of  Pharmaceutical  Laboratory,  College  of  Pharmacy  of  the  City  of 
New  York.     395  Illustrations.     Octavo.     500  pages.  Cloth,  $3.50 

COHEN.  The  Throat  and  Voice.  By  J.  Solis-Cohen,  m.d.  Illus.  i2mo.   Cloth,  .40 

COLLIE,  On  Fevers.  A  Practical  Treatise  on  Fevers,  Their  History,  Etiology, 
Diagnosis,  Prog-nosis,  and  Treatment.  By  Alexander  Collie,  m.d.,  m.r.c.p., 
Lond.,  Medical  Officer  of  the  Homerton  and  of  the  London  Fever  Hospitals. 
With  Colored  Plates.     i2mo.  Cloth,  $2.00 


MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  9 

COOPER.  Syphilis.  By  Alfred  Cooper,  f.r.c.s.,  Senior  Surcjeon  to  St.  Mark's 
Hospital  ;  late  Surgeon  to  the  London  Lock  Hospital,  etc.  Edited  by  Edward 
CoTTERELL,  F.R.C.S.,  Surgeon  London  Lock  Hospital,  etc.  Second  Edition. 
Enlarged  and  Illustrated  with  20  Full-page  Plates  containing  many  handsome 
Colored  Figures.     Octavo.  -  Cloth,  1:5.00 

COPLIN  and  SEVAN.  Practical  Hygiene.  By  W.  M.  L.  Coplin,  m.d..  Adjunct 
Professor  of  Hygiene,  Jefferson  Medical  College,  Philadelphia,  and  D.  Bevan, 
M.D.,  Ass't  Department  of  Hygiene,  Jefferson  Medical  College;  Bacteriologist, 
St.  Agnes'  Hospital,  Philadelphia,  with  an  Introduction  by  Prof.  H.  A.  Hare, 
and  articles  on  Plumbing,  Ventilation,  etc.,  by  Mr.  W.  P.  Lockington,  Editor  of 
the  Architectural  Era.     138  Illustrations,  some  of  which  are  in  colors.     8vo. 

Cloth,  $3.25 

CROCKER.  Diseases  of  the  Skin.  Their  Description,  Pathology,  Diagnosis,  and 
Treatment,  with  special  reference  to  the  Skin  Eruptions  of  Children.  By  H. 
Radcliffe  Crocker,  m.d.,  Physician  to  the  Dept.  of  Skin  Diseases,  University 
College  Hospital,  London.  92  Illustrations.  Second  Edition.  Enlarged.  987 
pages.     Octavo.  Cloth,  $4.50 

CULLINGWORTH.    A  Manual  of  Nursing,  Medical  and  Surgical.    By  Charles 

J.  CuLLiNGWORTH,    M.D.,    Physician  to  St.  Thomas'  Hospital,  London.     Third 

Revised  Edition.     With  18  Illustrations.     i2mo.  Cloth,  .75 

A  Manual  for  Monthly  Nurses.    Third  Edition.    32mo.  Cloth,  .40 

DALBY.  Diseases  and  Injuries  of  the  Ear.  By  Sir  William  B.  Dalby,  m.d., 
Aural  Surgeon  to  St.  George's  Hospital,  London.  Illustrated.  Fourth  Edition. 
With  28  Wood  Engravings  and  7  Colored  Plates.  Cloth,  $2.50 

DAVIS.  Biology.  An  Elementary  Treatise.  By  J.  R.  Ainsworth  Davis,  of 
University  College,  Aberystwyth,  Wales.   Thoroughly  Illustrated.    i2mo.      5(3.00 

DAVIS.  A  Manual  of  Obstetrics.  Being  a  complete  manual  for  Physicians  and 
Students.  By  Edward  P.  Davis,  m.d.,  Professor  of  Obstetrics  and  Diseases  of 
Infancy  in  the  Philadelphia  Polyclinic,  Clinical  Lecturer  on  Obstetrics,  Jeffer- 
son Medical  College ;  Professor  of  Diseases  of  Children  in  Woman's  Medical 
College,  etc.  Second  Edition,  Revised.  With  16  Colored  and  other  Lithograph 
Plates  and  134  other  Illustrations.     i2mo.  Cloth,  $2.00 

DAVIS.  Essentials  of  Materia  Medica  and  Prescription  Writing.  By  J. 
Aubrey  Davis,  m.d.,  Ass't  Dem.  of  Obstetrics  and  Quiz  Master  in  Materia 
Medica,  University  of  Pennsylvania;  Ass't  Physician,  Home  for  Crippled  Chil- 
dren, Philadelphia.     i2mo.  $1.50 

DAY.  On  Headaches.  The  Nature,  Causes,  and  Treatment  of  Headaches.  By 
Wm.  H.  Day,  m.d.     Fourth  Edition.     Illustrated.     8vo.  Cloth,  $1.00 

DOMVILLE.  Manual  for  Nurses  and  others  engaged  in  attending  to  the  sick.  By 
Ed.  J.  DoMViLLE,  m.d.  Seventh  Edition.  Revised.  With  Recipes  for  Sick- 
room Cookery,  etc.     121110.  Cloth,  .75 

DtJHRSSEN.  A  Manual  of  Gynecological  Practice.  By  Dr.  A.  Duhrssen, 
Privat-docent  in  Midwifery  and  Gynecology  in  the  University  of  Berlin.  Trans- 
lated from  the  Fourth  German  Edition  and  Edited  by  John  W.  Taylor,  f.r.c.s., 
Surgeon  to  the  Birmingham  and  Midlands  Hospital  for  Women  ;  Vice-President 
of  the  British  Gynecological  Society;  and  Frederick  Edge,  m.d.,  m.r.c.p., 
f.r.c.s.,  Surgeon  to  the  Wolverhampton  and  District  Hospital  for  Women.  With 
105  Illustrations.     121110.  Cloth,  $1.50 

The  book  presents  the  subject  of  Gynecology  in  small  compass.     The  work  has 

gone  rapidly  through  three  editions,  and  has  been  translated  into  French,  Italian, 

Russian,  and  Polish. 

DUCKWORTH.  On  Gout.  Illustrated.  A  treatise  on  Gout.  By  Sir  Dyce 
Duckworth,  m.d.  (Edin.),  f.r.c.p..  Physician  to,  and  Lecturer  on  Clinical 
Medicine  at,  St.  Bartholomew's  Hospital,  London.  With  Chromo-lithographs 
and  Engravings.     Octavo.  Cloth,  $6.00 


10  P,  BLAKISTON,  SON  &-  CO.'S 

DULLES.  What  to  Do  First,  In  Accidents  and  Poisoning.  By  C.  W.  Dulles,  m.d. 
Fourth  Edition,  Enlarged,  with  new  Illustrations.     i2mo.  Cloth.  $i.oo 

FAGGE.  The  Principles  and  Practice  of  Medicine.  By  C.  Hilton  Fagge,  m.d., 
F.R.c.p.  Edited  by  Philip  H.  Pye-Smith,  m.d.,  Lect.  on  Medicine  in  Guy's  Hos- 
pital. Including  a  Chapter  on  Cardiac  Diseases,  by  Samuel  Wilkes,  m.d.,  f.r.S., 
and  Complete  Indexes  by  Robert  Edmund  Carrington.    2  vols.     Royal  8vo. 

Cloth,  $7.00;    Leather,  $9.00  ;    Half  Russia,  $11.00 

FICK.  Diseases  of  the  Eye  and  Ophthalmoscopy.  A  Handbook  for  Physicians 
and  Students.  By  Dr.  Eugen  Fick,  University  of  Zurich.  Authorized  Transla- 
tion by  A.  B.  Hale,  m.d..  Assistant  to  the  Eye  Department,  Post-Graduate  Medi- 
cal School,  Chicago ;  late  Vol.  Assistant,  Imperial  Eye  Clinic,  University  of 
Kiel.     With  157  Illustrations,  many  of  which  are  in  colors.  In  Press. 

FIELD.  Evacuant  Medication — Cathartics  and  Emetics.  By  Henry  M.  Field, 
M.D.,  Professor  of  Therapeutics,  Dartmouth  Medical  College,  Corporate  Mem- 
ber Gynaecological  Society  of  Boston,  etc.     i2mo.     288  pp.  Cloth,  $1.75 

FILLEBROWN.  A  Text-Book  of  Operative  Dentistry.  Written  by  invitation 
of  the  National  Association  of  Dental  Faculties.  By  Thomas  Fillebrown,  m.d., 
D.M.D.,  Professor  of  Operative  Dentistry  in  the  Dental  School  of  Harvard  Uni- 
versity;  Member  of  the  American  Dental  Assoc,  etc.    Illus.    8vo.      Clo.,  $2.25 

FLAGG.  Plastics  and  Plastic  Fillings,  as  pertaining  to  the  filling  of  all  Cavities 
of  Decay  in  Teeth  below  medium  in  structure,  and  to  difficult  and  inaccessible 
cavities  in  teeth  of  all  grades  of  structure.  By  J.  Foster  Flagg,  d.d.s..  Professor 
of  Dental  Pathology  in  Philadelphia  Dental  College.  Fourth  Revised  Edition. 
With  many  Illustrations.     Svo.  Cloth,  $4.00 

FLOWER'S  Diagrams  of  the  Nerves  of  the  Human  Body.  Exhibiting  their 
Origin,  Divisions  and  Connections,  with  their  Distribution  to  the  various  Regions 
of  the  Cutaneous  Surface  and  to  all  the  Muscles.  By  William  H.  Flower, 
F.R.C.S.,  F.R.S. ,  Hunterian  Professor  of  Comparative  Anatomy,  and  Conservator 
of  the  Museum  of  the  Royal  College  of  Surgeons.  Third  Edition,  thoroughly 
revised.     With  six  Large  Folio  Maps  or  Diagrams.     4to,  Cloth,  ^^2.50 

FOWLER'S  Dictionary  of  Practical  Medicine.  Pj  Various  Writers.  An  Ency- 
clopedia of  Medicine.  Edited  by  James  Kingston  Fowler,  m.a.,  m.d.,  f.r.c.p.. 
Senior  Asst.  Physician  to,  and  Lecturer  on  Pathological  Anatomy  at,  the  Mid- 
dlesex Hospital,  London.     Svo.  Cloth,  $3.00 ;  Half  Morocco,  I4.00 

FOX.  Water,  Air  and  Food.  Sanitary  Examinations  of  Water,  Air  and  Food. 
By  Cornelius  B.  Fox,  m.d.    iio  Engravings.    2d  Ed.,  Revised.        Cloth,  I3.50 

FOX   AND   GOULD.     Compend  on  Diseases  of  the  Eye  and  Refraction, 

including  Treatment  and  Surgery.  By  L.  Webster  Fox,  m.d.,  late  Chief  Clini- 
cal Assistant,  Ophthalmological  Department,  Jefferson  Medical  College  Hospital, 
etc.,  and  Geo.  M.Gould,  M.D.  Second  Edition.  Enlarged.  71  Illustrations  and 
39  Formulas.     Being  No.  8,  f  Quiz- Compend?  Series. 

Cloth,  .80.     Interleaved  for  the  addition  of  notes,  $1.25 
FULLERTON.    Obstetrical  Nursing.    By  Anna  M.  Fullerton,  m.d.,  Demon- 
strator of  Obstetrics  in  the  Woman's  Medical  College ;    Physician    in    charge 
of,  and  Obstetrician  and  Gynecologist  to,  the  Woman's  Hospital,  Philadelphia, 
etc.    38  Illustrations.   Third  Edition.    Revised  and  Enlarged.    i2mo.  Cloth,  ^1.25 
Nursing  in  Abdominal  Surgery  and  Diseases  of  Women.    Comprising  the 
Regular  Course  of  Instruction  at  the   Training   School  of  the  Woman's 
Hospital,  Philadelphia.    Second  Ed.     70  Illustrations.     i2mo.     Cloth,  $1.50 

GARDNER.    The  Brewer,  Distiller  and  Wine  Manufacturer.    A  Handbook  for 

all  Interested  in  the  Manufacture  and  Trade  of  Alcohol  and  Its  Compounds. 

Edited  by  John  Gardner,  F.c.s.     Illustrated.  Cloth,  $1.50 

Bleaching,  Dyeing,  and  Calico  Printing.  With  Formulae.    Illustrated.     $1.50 


MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  11 

GA.IIROD.  On  Rheumatism.  A  Treatise  on  Rheumatism  and  Rheumatic  Arthritis. 
By  Archibald  Edward  Garrod,  m.a.  (Oxon.),  m.d.,  m.r.c.s.  (Eng.),  Asst. 
Physician,  West  London  Hospital.     Illustrated.     Octavo.  Cloth,  $5.00 

GILLIAM'S  Pathology.  The  Essentials  of  Pathology;  a  Handbook  for  Students. 
By  D.  Tod  Gilliam,  m.d..  Professor  of  Physiology,  Starling  Medical  College, 
Columbus,  O.    With  47  Illustrations.    i2mo.  Cloth,  .75 

GOODHART  and  STARR'S  Diseases  of  Children.  The  Student's  Guide  to  the 
Diseases  of  Children.  By  J.  F.  Goodhart,  m.d.,  F.R.C.P.,  Physician  to  Evelina 
Hospital  for  Childreri  and  to  Guy's  Hospital.  Second  American  from  the  Third 
English  Edition.  Rearranged  and  Edited,  with  notes  and  additions,  by  Louis 
Starr,  m.d..  Clinical  Professor  of  Diseases  of  Children  in  the  University  of 
Pennsylvania  ;  Physician  to  the  Children's  Hospital.  With  many  new  prescrip- 
tions. Cloth,  $2.50 

GORGAS'S  Dental  Medicine.  A  Manual  of  Materia  Medica  and  Therapeutics. 
By  Ferdinand  J.  S.  Gorgas,  m.d.,  d.d.s..  Professor  of  the  Principles  of  Dental 
Science,  Dental  Surgery  and  Dental  Mechanism  in  the  Dental  Dep.  of  the  Univ. 
of  Maryland.     Fifth  Edition.     Revised  and  Enlarged.     8vo.  Cloth,  ^4.00 

GOULD.    The  Illustrated  Dictionary  of  Medicine,  Biology,  and  Allied  Sciences. 

Being  an  Exhaustive  Lexicon  of  Medicine  and  those  Sciences  Collateral  to  it : 
Biology  (Zoology  and  Botany),  Chemistry,  Dentistry,  Pharmacology,  Microscopy, 
etc.  By  George  M.  Gould,  m.d..  Editor  of  The  Medical  News ;  President 
American  Academy  of  Medicine  ;  Ophthalmologist  Philadelphia  Hospital,  etc. 
With  many  Useful  Tables  and  numerous  Fine  Illustrations.  Large,  Square 
Octavo.     1633  pages.  Full  Sheep,  or  Half  Dark-Green  Leather,  $10.00 

Half  Russia,  Thumb  Index,  $12.00 
The  Medical  Student's  Dictionary.  Including  all  the  Words  and  Phrases 
generally  used  in  Medicine,  with  their  proper  Pronunciation  and  Definitions, 
based  on  Recent  Medical  Literature.  With  Tables  of  the  Bacilli,  Micrococci, 
Leucomains,  Ptomains,  etc.,  of  the  Arteries,  Muscles,  Nerves,  Ganglia  and 
Plexuses;  Mineral  Springs  of  U.  S.,  Vital  Statistics,  etc.  Small  octavo,  520 
pages.  Half  Dark  Leather,  $2.75;  Half  Morocco,  Thumb  Index,  $3.50 

The  Pocket  Pronouncing  Medical  Lexicon.  (12,000  Medical  Words 
Pronounced  and  Defined.)  A  Students'  Pronouncing  Medical  Lexicon. 
Containing  all  the  Words,  their  Definition  and  Pronunciation,  that  the 
Student  generally  comes  in  contact  with;  also  elaborate  Tables  of  the 
Arteries,  Muscles,  Nerves,  Bacilli,  etc.,  etc.;  a  Dose  List  in  both  English 
and  Metric  System,  etc.,  arranged  in  a  most  convenient  form  for  reference 
and  memorizing.     Just  Ready.     Thin  64.mo.     (6  x  2,j(  inches.) 

Full  Limp  Leather,  Gilt  Edges,  $1.00;  Thumb  Index,  $1.25 
*~^^  Saviple  pages  and  descriptive  circular  of  Gould's  Dictionaries  sent  free  upon 
apf>licatio7i.     See  page  4. 

GRIFFITH'S  Graphic  Clinical  Chart.  Designed  by  J.  P.  Crozer  Griffith, 
M.D.,  Instructor  in  Clinical  Medicine  in  the  University  of  Pennsylvania.  Printed 
in  three  colors.     Sample  copies  free.  Put  up  in  loose  packages  of  50,    .50 

Price  to  Hospitals,  500  copies,  $4.00;  1000  copies,  $7.50.     With  name  of  Hos- 
pital printed  on,  50  cents  extra. 

GROVES  AND  THORP.  Chemical  Technology.  A  new  and  Complete  Work. 
The  Application  of  Chemistry  to  the  Arts  and  Manufactures.  Edited  by 
Charles  E.  Groves,  f.r.s.,  and  Wm.  Thorp,  b.Sc,  f.i.c,  assisted  by  many 
experts.  In  about  eight  volumes,  with  numerous  illustrations.  Each  volume 
sold  separately. 

Vol.  I.   Fuel  and  Its  Applications.    607  Illustrations  and  4  Plates.    Octavo. 

Cloth,  $5.00;  Half  Morocco,  $6.50 
Vol.11.  Lighting.  Illustrated.  Octavo.  Cloth,  $4.00;  Half  Morocco,  55.50 
Vol.  III.     Lighting — Continued.  In  Press, 


12  P.  BLAKISTON,  SON  &-  CO:S 

GOWEES.  Manual  of  Diseases  of  the  Nervous  System.  A  Complete  Text-book. 
By  William  R.  Gowers,  m.d.,  f.r.s.,  Prof.  Clinical  Medicine,  University  College, 
London.  Physician  to  National  Hospital  for  the  Paralyzed  and  Epileptic.  Second 
Edition.  Revised,  Enlarged  and  in  many  parts  rewritten.  With  many  new 
Illustrations.     Two  Volumes.     Octavo. 

Vol.  I.    Diseases  of  the  Nerves  and  Spinal  Cord.    6i 6  pages.       Cloth,  $3.00 

Vol.  II.     Diseases  of   the   Brain    and    Cranial    Nerves;    General  and 

Functional  Diseases.     1069  pages.  Cloth,  $4.00 

Syphilis  and  the  Nervous  System.    Being  a  revised  reprint  of  the  Letiso- 

mian  Lectures  for  1890,  delivered  before  the  Medical  Society  of  London. 

i2mo.  Cloth,  $1.00 

Diagnosis  of  Diseases  of  the  Brain.    8vo.    Second  Ed.    lUus.    Cloth,  $1.50 

Medical  Ophthalmoscopy.    A  Manual  and  Atlas,  with  Colored  Autotype  and 

Lithographic  Plates  and  Wood-cuts,  comprising  Original  Illustrations  of  the 

changes  of  the  Eye  in  Diseases  of  the  Brain,  Kidney,  etc.     Third  Edition. 

Revised,  with  the  assistance  of  R.  Marcus  Gunn,  f.r.c.s.,  Surgeon,  Royal 

London  Ophthalmic  Hospital,  Moorfields.     Octavo.  Cloth,  $4.00 

The  Dynamics  of  Life.    i2mo.  Cloth,  .75 

Clinical  Lectures.     A  new  volume  of  Essays  on  the  Diagnosis,  Treatment, 
etc.,  of  Diseases  of  the  Nervous  System.  In  Press. 

HACKER.  Antiseptic  Treatment  of  Wounds,  Introduction  to  the,  according  to 
the  Method  in  Use  at  Professor  Billroth's  CHnic,  Vienna.  By  Dr.  Victor  R.  v. 
Hacker,  Assistant  in  the  Clinic  Billroth,  Professor  of  Surgery,  etc.  Translated 
by  Surgeon-Captain  C.  R.  Kilkelly,  m.b.     i2mo.  Cloth,  .50 

HAIG.  Causation  of  Disease  by  Uric  Acid.  A  Contribution  to  the  Pathology  of 
High  Arterial  Tension,  Headache,  Epilepsy,  Gout,  Rheumatism,  Diabetes, 
Bright's  Disease,  etc.  By  Alex.  Haig,  m.a.,  m.d.  (Oxon).,  f.r.c.p..  Physician  to 
Metropolitan  Hospital,  London.     Illustrated.     Second  Editio7i.  Cloth,  $3.00 

HALE.    On  the  Management  of  Children  in  Health  and  Disease.       Cloth,  .50 

HALL.  Compend  of  General  Pathology  and  Morbid  Anatomy.  ByH.NEWBERv 
Hall,  ph.g.,  m.d., Professor  of  Pathology  and  Medical  Chemistry;  Post-Graduate 
Medical  School ;  Surgeon  to  the  Emergency  Hospital,  Chicago  ;  Chief  Ear  Clinic, 
Chicago  Medical  College,  etc.  With  91  Illustrations.  No.  75  ?  Quiz- Compend  ? 
Series.  Cloth,  .80.     Interleaved  for  Notes,  $1.25 

Compend  of  Diseases  of  the  Ear  and  Nose.    Illustrated.  No.  16  f  Quiz- 
Compend?  Series.  Cloth,  .80.     Interleaved  for  Notes,  $1.25 

HALL.  Diseases  of  the  Nose  and  Throat.  By  F.  De  Havilland  Hall,  m.d., 
F.R.C.P.  (Lond.),  Physician  in  charge  Throat  Department  Westminster  Hospital; 
Joint  Lecturer  on  Principles  and  Practice  of  Medicine,  Westminster  Hospital 
Medical  School,  etc.     Two  Colored  Plates  and  59  Illus.     i2mo.  Cloth,  $2.50 

HANSELL  and  BELL.  Clinical  Ophthalmology,  Illustrated.  A  Manual  for 
Students  and  Physicians.  By.  Howard  F.  Hansell,  a.m.,  m.d..  Lecturer  on 
Ophthalmology  in  the  Jefferson  College  Hospital,  Philadelphia,  etc.,  and  James 
H.  Bell,  m.d.,  late  Demonstrator  of  Anatomy  in  Jefferson  Medical  College; 
Member  Ophthalmic  Staff,  Jefferson  College  Hospital;  Ophthalmic  Surgeon, 
Southwestern  Hospital,  Phila.  With  Colored  Plate  of  Normal  Fundus  and  120 
Illustrations.     i2mo.  Cloth,  $1.50 

HARE.  Mediastinal  Disease.  The  Pathology,  Clinical  History  and  Diagnosis  cf 
Affections  of  the  Mediastinum  other  than  those  of  the  Heart  and  Aorta.  By  H.  A. 
Hare,  m.d.  (Univ.  of  Pa.),  Professor  of  Materia  Medica  and  Therapeutics  in 
Jefferson  Medical  College,  Phila.     8vo.     Illustrated  by  Six  Plates.       Cloth,  ^2.00 


MEDICAL  AND  SCIENTIFIC  PUBLIC  A  TIONS.  13 

HARLAN.     Eyesight,  and  How  to  Care  for  It.     By  George  C.  Harlan,  m.d., 
Prof,  of  Diseases  of  the  Eye,  Philadelphia  Polyclinic.     Illustrated.         Cloth,  .40 
HAKEIS'S  Principles  and  Practice  of  Dentistry.    Including  Anatomy,  Physi- 
ology, Pathology,  Therapeutics,  Dental  Surgery  and  Mechanism.     By  Chapin  A. 
Harris,  m.d.,  d.d.s.,  late  President  of  the  Baltimore  Dental  College,  author  of 
"Dictionary  of  Medical  Terminology  and  Dental  Surgery."     Twelfth  Edition. 
Revised  and  Edited  by  Ferdinand  J.  S.  Gorgas,  a.m.,  m.d.,  d.d.s.,  author  of 
"Dental   Medicine;"    Professor  of  the  Principles   of   Dental   Science,   Dental 
Surgery  and  Dental  Mechanism  in  the  University  of  Maryland.     1086  Illustra- 
tions.   1225  pages.    8vo.  Cloth,  $6.00;  Leather,  $7.00 
Dictionary  of  Dentistry.     Fifth  Edition,  Revised.     Including  Definitions  of 
such  Words  and  Phrases  of  the  Collateral  Sciences  as  Pertain  to  the  Art  and 
Practice  of  Dentistry.     Fifth    Edition.     Rewritten,  Revised  and  Enlarged. 
By  Ferdinand  J.  S.  Gorgas,  m.d.,  d.d.s..  Author  of  "  Dental  Medicine  ;  " 
Editor  of  Harris's   "Principles   and    Practice  of  Dentistry;"   Professor  of 
Principles  of  Dental  Science,  Dental  Surgery,  and  Prosthetic  Dentistry  in  the 
University  of  Maryland.     Octavo.                           Cloth,  $4.50;  Leather,  $5.50 

HARRIS  and  BEALE.  Treatment  of  Pulmonary  Consumption.  By  Vincent 
Dormer  Harris,  m.d.  (Lond.),  f.r.c.p..  Physician  to  the  city  of  London  Hospi- 
tal for  Diseases  of  the  Chest ;  Examining  Physician  to  the  Royal  National  Hos- 
pital for  Diseases  of  the  Chest,  Ventnor,  etc.,  and  E.  Clifford  Beale,  m.a., 
M.B.  (Cantab.),  F.R.C.P.,  Physician  to  the  city  of  London  Hospital  for  Diseases 
of  the  Chest,  and  to  the  Great  Northern  Central  Hospital,  etc.  A  Practical 
Manual.     i2mo.  Nearly  Ready. 

HARTRIDGE.  Refraction.  The  Refraction  of  the  Eye.  A  Manual  for  Students. 
By  GusTAVus  Hartridge,  f.r.c.s.,  Consulting  Ophthalmic  Surgeon  to  St.  Bar- 
tholomew's Hospital ;  Ass't  Surgeon  to  the  Royal  Westminster  Ophthalmic  Hos- 
pital, etc.  98  Illustrations  and  Test  Types.  Seventh  Edition,  Cloth,  $1.00 
On  The  Ophthalmoscope.  A  Manual  for  Physicians  and  Students.  Second 
Edition.    With  Colored  Plates  and  many  Woodcuts.     i2mo.        Cloth,  $1.25 

HARTSHORNE.  Our  Homes.  Their  Situation,  Construction,  Drainage,  etc.  By 
Henry  Hartshorne,  m.d.     Illustrated.  Cloth,  .40 

HATFIELD.  Diseases  of  Children.  By  Marcus  P.  Hatfield,  Professor  of 
Diseases  of  Children,  Chicago  Medical  College.  With  a  Colored  Plate.  Being 
No.i4,f  Qiiiz-Compe7id?  Series.     i2mo.  Cloth,  .80 

Interleaved  for  the  addition  of  notes,  $1.25 

HEATH'S  Minor  Surgery  and  Bandaging.    By  Christopher  Heath,  f.r.c.s., 

Holme   Professor  of  Clinical   Surgery   in   University  College,  London.     Tenth 

Edition,      Revised  and   Enlarged.     With   158    Illustrations,  62  Formulas,  Diet 

List,  etc.     i2mo.  Cloth,  J1.25 

Practical  Anatomy.      A  Manual  of  Dissections.      Eighth  London   Edition. 

300  Illustrations.  Cloth,  1:4.25 

Injuries  and  Diseases  of  the  Jaws.    Fourth  Edition.    Edited  by  Henry 

Percy   Dkan,    m.s.,  f.r.c.s.,  Assistant   Surgeon    London  Hospital.     With 

187  Illustrations.    8vo.  Cloth,  $4.50 

Lectures  on  Certain  Diseases  of  the  Jaws,  delivered  at  the  Royal  College  of 
Surgeons  of  England,  1887.     64  Illustrations.     8vo.  Boards,  .50 

HENRY.  Anaemia,  A  Practical  Treatise.  By  Fred'k  P.  Henry,  m.d.,  Physician 
to  Episcopal  Hospital,  Philadelphia.  Half  Cloth,  ,50 

HIGGENS' Ophthalmic  Practice.  By  Charles  Higgens,  f.r.c.s.  Illus.  Cloth,  $1.50 

HILTON.     Rest  and  Pain.     A  Course  of  Lectures  on  the  Influence  of  Mechanical 

and  Physiological  Rest  in  the  Treatment  of  Accidents  and  Surgical  Diseases 

and  the  Diagnostic  Value  of  Pain.     By  John  Hilton,  f.r.s.     Edited  by  W.  H. 

A.  Jacobson,  f.r.c.s.     Octavo.     504  pages.  Cloth,  $2.50 


14  P.  BLAKISTON,  SON  6-  CO:S 

HILL  AND  COOPER.  Venereal  Diseases.  The  Student's  Manual  of  Venereal 
Diseases,  being  a  concise  description  of  those  Affections  and  their  Treatment. 
By  Berkeley  Hill,  m.d.,  Professor  of  Clinical  Surgery,  University  College,  and 
Arthur  Cooper,  m.d.,  Late  House  Surgeon  to  the  Lock  Hospital,  London. 
4th  Edition.     i2mo.  Cloth,  .75 

HOLDEN'S  Anatomy.  Sixth.  Edition.  A  Manual  of  the  Dissections  of  the  Human 
Body.  By  John  Langton,  f.r.c.s..  Surgeon  to,  and  Lecturer  on  Anatomy  at, 
St.  Bartholomew's  Hospital.  Carefully  Revised  by  A.  Hewson,  m.d..  Demonstra- 
tor of  Anatomy,  Jefferson  Medical  College;  Chief  of  Surgical  Clinic,  Jefferson 
Hospital;  Mem.  Assoc.  Amer.  Anatomists,  etc.  311  Illustrations.  i2mo.  800 
pages.  Cloth,  $2.50;  Oil-cloth,  ^2.50;  Leather,  $3.00 

Human  Osteology.  Comprising  a  Description  of  the  Bones,  with  Colore 
Delineations  of  the  Attachments  of  the  Muscles.  The  General  and  Micro- 
scopical Structure  of  Bone  and  its  Development.  Carefully  Revised,  by 
the  Author  and  Prof.  Stewart,  of  the  Royal  College  of  Surgeons'  Museum. 
With  Lithographic  Plates  and  Numerous  Illustrations.  7th  Ed.  Cloth,  $5.25 
Landmarks.     Medical  and  Surgical.     4th  Edition.     8vo.  Cloth,  $1.00 

HOLLAND.  The  Urine,  the  Gastric  Contents,  the  Common  Poisons  and  the 
Milk.  Memoranda,  Chemical  and  Microscopical,  for  Laboratory  Use.  By  J.  W. 
Holland,  m.d..  Professor  of  Medical  Chemistry  and  Toxicology  in  Jefferson 
Medical  College,  of  Philadelphia.  Fifth  Edition,  Enlarged.  Illustrated  and 
Interleaved.  i2mo.  Cloth,  $1.00 

HORSLEY.  The  Brain  and  Spinal  Cord.  The  Structure  and  Functions  of.  Being 
the  Fullerian  Lectures  on  Physiology  for  1891.  By  Victor  A.  Horsley,  m.6., 
F.R.S.,  etc..  Assistant  Surgeon,  University  College  Hospital,  Professor  of  Pathology, 
University  College,  London,  etc.     With  numerous  Illustrations.  Cloth,  $2.50 

HORWITZ'S  Compend  of  Surgery,  including  Minor  Surgery,  Amputations,  Frac- 
tures, Dislocations,  Surgical  Diseases,  and  the  Latest  Antiseptic  Rules,  etc.,  with 
Differential  Diagnosis  and  Treatment.  By  Orville  Horwitz,  b.s.,  m.d.,  Pro- 
fessor of  Genito-Urinary  Diseases,  late  Demonstrator  of  Surgery,  Jefferson  Medi- 
cal College.  Fifth  Edition.  Very  much  Enlarged  and  Rearranged.  Over  300 
pages.     167  Illustrations  and  98  Formulae.    i2mo.  No.  g  ?  Quiz- Compend  f  Series. 

Cloth,  .80.     Interleaved  for  notes,  $1.25 

HTJGHES.    Compend  of  the  Practice  of  Medicine.    Fifth  Edition.    Revised  and 

Enlarged.    By  Daniel  E.  Hughes,  m.d..  Demonstrator  of  Clinical  Medicine  at 

Jefferson  Medical  College,  Philadelphia.     In  two  parts.     Being  Nos.  2  aftd  j>, 

f  Quiz- Compend  f  Series. 

Part  I. — Continued,  Eruptive  and  Periodical  Fevers,  Diseases  of  the  Stomach, 
Intestines,  Peritoneum,  Biliary  Passages,  Liver,  Kidneys,  etc.,  and  General 
Diseases,  etc. 

Part  II. — Diseases  of  the  Respiratory  System,  Circulatory  System  and  Ner- 
vous System  ;  Diseases  of  the  Blood,  etc. 

Price  of  each  Part,  in  Cloth,  .80 ;  interleaved  for  the  addition  of  Notes,  $1.25 
Physicians'  Edition. — In  one  volume,  including  the  above  two  parts,  a  sec- 
tion  on  Skin  Diseases,   and  an  index.      Fifth  revised,  enlarged  Edition. 
§68  pages.  Full  Morocco,  Gilt  Edge,  ^2.25 

"  Carefully  and  systematically  compiled." — The  London  Lancet. 

HUMPHREY.  A  Manual  for  Nurses.  Including  general  Anatomy  and  Physiology, 
management  of  the  sick-room,  etc.  By  Laurence  Humphrey,  m.a.,  m.b., 
M.R.C.S.,  Assistant  Physician  to,  and  Lecturer  at,  Addenbrook's  Hospital,  Cam- 
bridge, England.     Thirteenth  Edition.     i2mo.     Illustrated.  Cloth,  $1.00 

HYSLOP'S  MENTAL  PHYSIOLOGY.  Especially  in  Relation  to  Mental  Dis- 
orders. By  Theo.  B.  Hyslop,  m.d.,  Assistant  Physician,  Bethlem  Royal  Hos- 
pital.    20  Illustrations.     i2mo.  In  Press. 


MEDICAL  AND  SCIENTIFIC  PUBLICATIONS.  15 

HOVELL.  Diseases  of  the  Ear  and  Naso-Pharynx.  A  Treatise  including 
Anatomy  and  Physiology  of  the  Organ,  together  with  the  treatment  of  the  affec- 
tions of  the  Nose  and  Pharynx  which  conduce  to  aural  disease.  By  T.  Mark 
HovELL,  F.R.c.s.  (Edin.),  m.r.c.s.  (Eng.),  Aural  Surgeon'to  the  London  Hospital, 
to  Hospital  for  Diseases  of  the  Throat,  and  to  British  Hospital  for  Incurables, 
etc.     122  Illustrations.     Octavo.  Cloth,  $5.00 

HUTCHINSON.  The  Nose  and  Throat.  A  Manual  of  the  Diseases  of  the  Nose 
and  Throat,  including  the  Nose,  Naso-Pharynx,  Pharynx  and  Larynx.  By 
Procter  S.  Hutchinson,  m.r.c.s.,  Ass't  Surgeon  to  the  London  Hospital  for 
Diseases  of  the  Throat.  Illustrated  by  Lithograph  Plates  and  40  other  lUus., 
many  of  which  have  been  made  from  original  drawings.    i2mo.    2d  Ed.    In  Press. 

JACOBSON.  Operations  of  Surgery.  By  W.  H.  A.  Jacobson,  b.a,  oxon,, 
F.R  C.S.,  Eng.;  Ass't  Surgeon,  Guy's  Hospital;  Surgeon  at  Royal  Hospital  for 
Children  and  Women,  etc.     With  over  200  Illust.      Cloth,  $3.00  ;  Leather,  $4.00 

Diseases  of  the  Male  Organs  of  Generation.    88  Illustrations.    8vo. 

Cloth,  $6.00 

KENWOOD.    Public  Health  Laboratory  Work.     By  H.  R.  Kenwood,  m.b., 

D.P.H.,  F.C.S.,  Instructor  in  Hygienic  Laboratory,  University  College,  late  Assistant 

Examiner  in  Hygiene,  Science  and  Art  Department,  South  Kensington,  London, 

etc.     With  116  Illustrations  and  3  Plates.  Cloth,  $2.00 

EIRKES'  Physiology.  {13th  Aiitho7-ised  Edition,  Just  Ready.  i2mo.  Dark  Red 
Cloth.')  A  Handbook  of  Physiology.  Thirteenth  London  Edition,  Revised  and 
Enlarged.  By  W.  Morrant  Baker,  m.d..  and  Vincent  Dormer  Harris,  m.d. 
516  Illustrations,  some  of  which  are  printed  in  Colors.     i2mo. 

Cloth,  1:3.25  ;  Leather,  ^4  00 

KLEEN  AND  HARTWELL.  Handbook  of  Massage.  By  Emil  Kleen,  m.d., 
PH.D.,  Stockholm  and  Carlsbad.  Authorized  Translation  from  the  Swedish,  by 
Edward  Mussey  Hartwell,  m.d.,  ph.d.,  Director  of  Physical  Training  in  the 
Public  Schools  of  Boston.  With  an  Introduction  by  Dr.  S.  Weir  Mitchell, 
of  Philadelphia.  Illustrated  with  a  series  of  Photographs  made  specially  by 
Dr.  Kleen  for  the  American  Edition.     Svo.  Cloth,  $2.25 

LANDIS'  Compend  of  Obstetrics  ;  especially  adapted  to  the  Use  of  Students  and 
Physicians.  By  Henry  G.  Landis,  m.d.  Fifth  Edition.  Revised  by  Wm.  H. 
Wells,  Assistant  Demonstrator  of  Clinical  Obstetrics,  Jefferson  Medical  College; 
Member  Obstetrical  Society  of  Philadelphia,  etc.  Enlarged.  With  Many  Iltus- 
trations.     No.  ^  f  Quiz- Compend?  Series. 

Cloth,  .80;  interleaved  for  the  addition  of  Notes,  I1.25 

LANDOIS.  A  Text-Book  of  Human  Physiology  ;  including  Histology  and  Micro- 
scopical Anatomy,  with  special  reference  to  the  requirements  of  Practical  Medi- 
cine. By  Dr.  L.  Landois,  Professor  of  Physiology  and  Director  of  the  Physio- 
logical Institute  in  the  University  of  Greifswald.  Fourth  American,  translated 
from  the  Seventh  German  Edition,  with  additions,  by  Wm.  Stirling,  m.d.,  d.Sc, 
Brackenbury  Professor  of  Physiology  and  Histology  in  Owen's  College,  and  Pro- 
fessor in  Victoria  University,  Manchester  ;  Examiner  in  Physiology  in  University 
of  Oxford,  England.  With  845  Illustrations,  many  of  which  are  printed  in 
Colors.     2  Volumes.     Svo.  Cloth,  $7.00 

"The  MOST  complete  resumi  of  all  the  facts  in  physiology  in  the  language." — The  Lancet. 
"Excellently  clear,  attractive,  and  succinct." — British  Medicat  Joumat. 

LEE.  The  Microtomist's  Vade  Mecum.  Third  Edition.  A  Handbook  of 
Methods  of  Microscopical  Anatomy.  By  Arthur  Bolles  Lee,  Ass't  in  the  Rus- 
sian Laboratory  of  Zoology,  at  \'illefranche-sur-Mer  (Nice).  881  Articles.  En- 
larged and  Revised.     Octavo.  Cloth,  ;f;4.oo 


16  P.  BLAKISTON,  SON  <&-  CO:S 

LEFFMANN'S  Compend  of  Medical  Chemistry,  Inorganic  and  Organic.  In- 
cluding Urine  Analysis.  By  Henry  Leffmann,  m.d.,  Prof,  of  Chemistry  and 
Metallurgy  in  the  Penna.  College  of  Dental  Surgery  and. in  the  Wagner  Free 
Institute  of  Science,  Philadelphia.  No.  lo  f  Quiz- Compend?  Series.  Fourth 
Edition.    Rewritten.  Cloth,  .80.    Interleaved  for  the  addition  of  Notes,  $1.25 

The  Coal-Tar  Colors,  with  Special  Reference  to  their  Injurious  Qualities  and 
the  Restrictions  of  their  Use.  A  Translation  of  Theodore  Weyl's  Mono- 
graph.    i2mo.  Cloth,  ^1.25 

Progressive  Exercises  in  Practical  Chemistry.  A  Laboratory  Handbook. 
Illustrated.     Second  Edition,  Revised  and  Enlarged.     i2mo.      Cloth,  $1.00 

Examination  of  Water  for  Sanitary  and  Technical  Purposes.  Third  Edition. 
Enlarged.     Illustrated.     i2mo.  Cloth,  $1.25 

Analysis  of  Milk  and  Milk  Products.     Arranged  to  suit  the  needs  of  Analyt- 
ical Chemists,  Dairymen,  and  Milk  Inspectors.     i2mo.  Cloth,  $1.25 
LEGG    on  the  Urine.      Practical    Guide   to   the   Examination    of  Urine.      By  J. 
WiCKHAM  Legg,  m.d.     Seventh  Edition,  Enlarged.     Edited  and  Revised  by  H. 
Lewis  Jones,  m.a.,  m.d.,  m.r.c.p.     Illustrated.     i2mo.  Cloth,  $1.00 

lEWERS.  On  the  Diseases  of  Women.  A  Practical  Treatise.  By  Dr.  A.  H. 
N.  Lewers,  Assistant  Obstetric  Physician  to  the  London  Hospital ;  and  Phy- 
sician to  Out-patients,  Queen  Charlotte's  Lying-in  Hospital ;  Examiner  in  Mid- 
wifery and  Diseases  of  Women  to  the  Society  of  Apothecaries  of  London.  With 
146  Engravings.     Third  Edition,  Revised.  Cloth,  $2.00 

LEWIS  (BEVAN).  Mental  Diseases.  A  text-book  having  special  reference  to  the 
Pathological  aspects  of  Insanity.  By  Bevan  Lewis,  l.r.c.p.,  m.r.c.s..  Medi- 
cal Director,  West  Riding  Asylum,  W^akefield,  England.  18  Lithographic  Plates 
and  other  Illustrations.     8vo.  Cloth,  ^5.00 

LINCOLN.    School  and  Industrial  Hygiene.    By  D.  F.  Lincoln,  m.d.    Cloth,  .40 
LIZARS  (JOHN).     On  Tobacco.     The  Use  and  Abuse  of  Tobacco.  Cloth,  .40 

LONGLEY'S  Pocket  Medical  Dictionary  for  Students  and  Physicians.  Giving 
the  Correct  Definition  and  Pronunciation  of  all  Words  and  Terms  in  General 
Use  in  Medicine  and  the  Collateral  Sciences,  with  an  Appendix,  containing 
Poisons  and  their  Antidotes,  Abbreviations  Used  in  Prescriptions,  and  a  Metric 
Scale  of  Doses.     By  Eli  as  Longley.  Cloth,  .75;  Tucks  and  Pocket,  $1.00 

MACALISTER'S  Human  Anatomy.  800  Illustrations.  A  New  Text-book  for 
Students  and  Practitioners.  Systematic  and  Topographical,  including  the 
Embryology,  Histology  and  Morphology  of  Man,  With  special  reference  to  the 
requirements  of  Practical  Surgery  and  Medicine.  By  Alex.  Macalister,  m.d., 
F.R.S.,  Professor  of  Anatomy  in  the  University  of  Cambridge,  England ;  Examiner 
in  Zoology  and  Comparative  Anatomy,  University  of  London ;  formerly  Professor 
of  Anatomy  and  Surgery,  University  of  Dublin.  With  816  Illustrations,  400  of 
which  are  original.     Octavo.  Cloth,  ^5.00;  Leather,  $6.co 

MACDONALD'S  Microscopical  Examinations  of  Water  and  Air.  With  an  Ap- 
pendix on  the  Microscopical  Examination  of  Air.  By  J.  D.  Macdonald,  m.d. 
25  Lithographic  Plates,  Reference  Tables,  etc.     Second  Ed.     8vo.     Cloth,  $2.50 

MACKENZIE.  The  Pharmacopoeia  of  the  London  Hospital  for  Diseases  of 
the  Throat.  By  Sir  Morell  Mackenzie,  m.d.  Fifth  Edition.  Revised  and 
Improved  by  F.  G.  Harvey,  Surgeon  to  the  Hospital.  Cloth,  $1.00 

MACNAMARA.  On  the  Eye.  A  Manual.  By  C.  Macnamara,  m.d.  Fifth 
Edition,  Carefully  Revised ;  with  Additions  and  Numerous  Colored  Plates,  Dia- 
grams of  Eye,  Wood-cuts,  and  Test  Types.     Demi  8vo.  Cloth,  ^^3.50 


MEDICAL  AND  SCIENTIFIC  PUBLIC  A  TIONS.  17 

MACREADY.  A  Treatise  on  Ruptures.  By  Jonathan  F.  C.  H.  Macready, 
F.R.C.S.,  Surgeon  to  the  Great  Northern  Central  Hospital ;  to  the  City  of  London 
Hospital  for  Diseases  of  the  Chest ;  to  the  City  of  London  Truss  Society,  etc. 
With  24  full-page  Lithographed  Plates  and  numerous  Wood-Engravings.   Octavo. 

Cloth,  $6.00 

MANN.  Forensic  Medicine  and  Toxicology.  A  Text-Book  by  J.  Dixon  Mann, 
M.D.,  F.R.C.P.,  Professor  of  Medical  Jurisprudence  and  Toxicology  in  Owens  Col- 
lege, Manchester;  Examiner  in  Forensic  Medicine  in  University  of  London,  etc. 
Illustrated.     Octavo.  Cloth,  $6.50 

MANN'S  Manual  of  Psychological  Medicine  and  Allied  Nervous  Diseases.  Their 
Diagnosis,  Pathology,  Prognosis  and  Treatment,  including  their  Medico-Legal 
Aspects  ;  with  chapter  on  Expert  Testimony,  and  an  abstract  of  the  laws  relating 
to  the  Insane  in  all  the  States  of  the  Union.  By  Edward  C.  Mann,  m.d., 
member  of  the  New  York  County  Medical  Society.  With  Illustrations  of  Typical 
Faces  of  the  Insane,  Handwriting  of  the  Insane,  and  Micro-photographic  Sec- 
tions of  the  Brain  and  Spinal  Cord.  Octavo.  Cloth,  $3.00 
MARSHALL'S  Physiological  Diagrams,  Life  Size,  Colored.  Eleven  Life-size 
Diagrams  (each  7  feet  by  3  feet  7  inches).  Designed  for  Demonstration  before 
the  Class.  By  John  Marshall,  f.r.s.,  f.r.c.s..  Professor  of  Anatomy  to  the 
Royal  Academy  ;  Professor  of  Surgery,  University  College,  London,  etc. 

In  Sheets  Unmounted,  $40.00 
Backed  with  Muslin  and  Mounted  on  Rollers,  $60.00 
Ditto,  Spring  Rollers,  in  Handsome  Walnut  Wall  Map  Case  (Send  for 

Special  Circular), $100.00 

Single  Plates,  Sheets,  $5.00;  Mounted,  $7.50;  Explanatory  Key,  50  cents. 
No.  I — The  Skeleton  and  Ligaments.  No.  2 — The  Muscles  and  Joints,  with 
Animal  Mechanics.  No.  3 — The  Viscera  in  Position.  The  Structure  of  the  Lungs. 
No.  4 — The  Heart  and  Principal  Blood-vessels.  No.  5 — The  Lymphatics  or  Absorb- 
ents. No.  6 — The  Digestive  Organs.  No.  7 — The  Brain  and  Nerves.  Nos.  8  and  9 — 
The  Organs  of  the  Senses.  Nos.  10  and  11 — The  Microscopic  Structure  of  the 
Textures  and  Organs.     {Send for  Special  Circular.) 

MARSHALL  &  SMITH.  On  the  Urine.  The  Chemical  Analysis  of  the  Urine. 
By  John  Marshall,  m.d.,  and  Prof.  Edgar  F.  Smith,  of  the  Chemical  Labora- 
tories. University  of  Pennsylvania.  Phototype  Plates.  i2mo.  Cloth,  $1.00 
MASON'S  Compend  of  Electricity,  and  its  Medical  and  Surgical  Uses.  By 
"Charles  F.  Mason,  m.d..  Assistant  Surgeon  U.  S.  Army.  With  an  Intro- 
duction by  Charles  H.  May,  m.d.,  Instructor  in  the  New  York  Polyclinic. 
Numerous  Illustrations.     i2mo.                   •  Cloth,  .75 

MAXWELL.  Terminologia  Medica  Polyglotta.  By  Dr.  Theodore  Maxwell, 
assisted  by  others  in  various  countries.     8vo.  Cloth,  $3.00 

The  object  of  this  work  is  to  assist  the  medical  men  of  any  nationality  in  reading  medical  literature  written 
in  a  language  not  their  own.  Each  term  is  usually  given  in  seven  languages,  viz.  :  English,  French,  German, 
Italian,  Spanish,  Russian  and  Latin. 

MAYS'  Therapeutic  Forces  ;  or.  The  Action  of  Medicine  in  the  Light  of  the  Doc- 
trine of  Conservation  of  Force.     By  Thomas  J.  Mays,  m.d.  Cloth,  $1.25 
Theine  in  the  Treatment  of  Neuralgia.    i6mo.                        %  bound,  .50 

McBRIDE.  Diseases  of  the  Throat,  Nose  and  Ear.  A  Clinical  Manual  for  Stu- 
dents and  Practitioners.  By  P.  McBkide,  m.d.,  f.r.c.p.  (Edin.),  Surgeon  to  the 
Ear  and  Throat  Department  of  the  Royal  Infirmary;  Lecturer  on  Diseases  of 
Throat  and  Ear,  Edinburgh  School  of  Medicine,  etc.  With  Colored  Illustrations 
from  Original  Drawings.    2d  Edition.    Octavo.       Handsome  Cloth,  Gilt  top,  $6.00 

McNEILL.  The  Prevention  of  Epidemics  and  the  Construction  and  Man- 
agement of  Isolation  Hospitals.  By  Dr.  Roger  McNeill,  Medical  Officer  of 
Health  for  the  County  of  Argyll.  'With  numerous  Plans  and  other  Illustrations. 
Octavo.  Cloth,  $3.50 


18  P.  BLAKISTON,  SON  &-  CO.'S 

MEICrS.  Milk  Analysis  and  Infant  Feeding.  A  Treatise  on  the  Examination  of 
Human  and  Cows'  Milk,  Cream,  Condensed  Milk,  etc.,  and  Directions  as  to  the 
Diet  of  Young  Infants.     By  Arthur  V.  Meigs,  m.d.     i2mo.  Cloth,  .50 

MEMMINGER.  Diagnosis  by  the  TJrine.  The  Practical  Examination  of  Urine, 
with  Special  Reference  to  Diagnosis.  By  Allard  Memminger,  m.d.,  Professor 
of  Chemistry  and  of  Hygiene  in  the  Medical  College  of  the  State  of  S.  C. ;  Visiting 
Physician  in  the  City  Hospital  of  Charleston,  etc.    23  Illus.    i2mo.     Cloth,  |;i.oo 

MEYER.  Ophthalmology.  A  Manual  of  Diseases  of  the  Eye.  By  Dr.  Edouard 
Meyer.  Translated  from  the  Third  French  Edition  by  A.  Freedland  Fer- 
gus, m.b.     270  Illustrations,  two  Colored  Plates.         Cloth,  $3.50;  Leather,  $4.50 

MONEY.  On  Children.  Treatment  of  Disease  in  Children,  including  the  Outlines 
of  Diagnosis  and  the  Chief  Pathological  Differences  between  Children  and 
Adults.  By  Angel  Money,  m.d.,  m.r.c.p.,  Ass't  Physician  to  the  Hospital  for 
Sick  Children,  Great  Ormond  St.,  London.     2d  Edition.     i2mo.         Cloth,  $2.50 

MORRIS.  Text-Book  of  Anatomy.  791  Illustrations,  many  in  Colors.  A  com- 
plete Text-book.  Edited  by  Henry  Morris,  f.r.c.s.,  Surg,  to,  and  Lect.  on 
Anatomy  at,  Middlesex  Hospital,  assisted  by  J.  Bland  Sutton,  f.r  c.s.,  J.  H. 
Davies-Colley,  f.r.c.s.,  Wm.  J.  Walsham,  f.r.c.s.,  H.  St.  John  Brooks,  m.d., 
R.  Marcus  Gunn,  f.r.c.s.,  Arthur  Hensman,  f.r.c.s.,  Frederick  Treves, 
f.r.c.s.,  William  Anderson,  f.r.c.s.,  and  Prof.  W.  H.  A.  Jacobson.  One 
Handsome  Octavo  Volume,  with  791  Illustrations,  214  of  which  are  printed  in 
colors.  Cloth,  ^6.00;  Leather,  $7.00;  Half  Russia,  $8.00 

"Taken  as  a  whole,  we  have  no  hesitation  in  according  very  high  praise  to  this  work.     It 

will  rank,  we  believe,  with  the  leading  Anatomies.     The  illustrations  are  handsome  and  the 

printing  is  good." — Boston  Medical  and  Surgical  Journal. 

Handsome  circular,  with  sample  pages  and  colored  illustrations,  will  be  sent  free 
to  any  address. 

MOULLIN.  Surgery.  Second  Edition,  by  Hamilton.  A  Complete  Text-book. 
By  C.  W.  Mansell  Moullin,  m.a.,  m.d.  oxon.,  f.r.c.s.,  Surgeon  and  Lec- 
turer on  Physiology  to  the  London  Hospital ;  formerly  Radcliffe  Traveling 
Fellow  and  Fellow  of  Pembroke  College,  Oxford.  Second  American  Edition. 
Revised  and  edited  by  John  B.  Hamilton,  m.d.,  ll.d.,  Professor  of  the  Principles 
of  Surgery  and  Clinical  Surgery,  Rush  Medical  College,  Chicago  ;  Professor  of 
Surgery,  Chicago  Polyclinic  ;  Surgeon,  formerly  Supervising  Surgeon-General, 
U.  S.  Marine  Hospital  Service;  Surgeon  to  Presbyterian  Hospital;  Consulting 
Surgeon  to  St.  Joseph's  Hospital  and  Central  Free  Dispensary,  Chicago,  etc. 
600  Illustrations,  over  200  of  which  are  original,  and  many  of  which  are  printed 
in  Colors.     Royal  Octavo.     1200  pages. 

Handsomely  bound  in  Cloth,  $6. 00;  Leather,  $7.00 
"  The  aim  to  make  this  valuable  treatise  practical  by  giving  special  attention  to  questions  of 
treatment  has  been  admirably  carried  out.  Many  a  reader  will  consult  the  work  with  a  feeling 
of  satisfaction  that  his  wants  have  been  understood,  and  that  they  have  been  intelligently  met. 
He  will  not  look  in  vain  for  Retails,  without  proper  attention  to  which  he  well  knows  that  the 
highest  success  is  impossible." — The  American  Journal  of  Medical  Scie^ices. 

Enlargement  of  the   Prostate.     Its  Treatment  and   Radical   Cure.     Illus- 
trated.    Octavo.  Cloth,  ^1.50 

MTJRRELL.     Massotherapeutics.     Massage  as  a  Mode  of  Treatment.     By  Wm. 
MuRRELL,  M.D.,  F.R.C.P.,  Lecturer  on  Pharmacology  and  Therapeutics  at  West- 
minster Hospital.     Fifth  Edition.    Revised.    i2mo.  Cloth,  I1.25 
Chronic  Bronchitis  and  its  Treatment.    {^Authorized  Edition!)    A  Clinical 
Study.     i2mo.     176  pages.  Cloth,  $1.50 
What  To  Do  in  Cases  of  Poisoning.     Seventh  Edition,   Enlarged  and  Re- 
vised.    64mo.                                                                                             Cloth,  $1.00 


MEDICAL  AND  SCIENTIFIC  PUBLICATIONS.  19 

MORTON"  on  Refraction  of  the  Eye.    Its  Diagnosis  and  the  Correction  of  its  Errors. 

With  Chapter  on  Keratoscopy,  and  Test  Types.     By  A.  Morton,  m.b.     Fifth 
Edition,  Revised  and  Enlarged.  Cloth,  Si.oo 

MXJSKETT.  Prescribing  and  Treatment  in  the  Diseases  of  Infants  and  Child- 
ren. By  Philip  E.  IVIuskett,  Late  Surgeon  to  the  Sydney  Hospital,  Formerly 
Senior  Resident  Medical  Officer,  Sydney  Hospital.     32mo.  Cloth,  51.25 

MUTER.  Practical  and  Analytical  Chemistry.  By  John  Muter,  f.r.s.,  f.c.s., 
etc.  Fourth  Edition.  Revised,  to  meet  the  requirements  of  American  Medical 
Colleges,  by  Claude  C.  Hamilton,  m.d.,  Professor  of  Analytical  Chemistry 
in  University  Med.  Col.  and  Kansas  City  Col.  of  Pharmacy.     51  Illus.    Cloth,  Si. 25 

"  Muter's  Manual  of  Analytical  Chemistry,  several  previous  editions  of  which  we  have 
noticed,  now  appears,  revised  in  an  American  edition  by  Dr.  Claude  C.  Hamilton.  This 
revision  is  based  upon  the  fourth  English  edition.  The  editor  has  made  only  such  changes  as 
were  required  to  adapt  the  book  to  the  U.  S.  Pharmacopoeia,  except  in  the  chapter  on  urine 
analysis,  which  has  been  enlarged  and  to  which  cuts  of  microscojiic  sediments  and  other  illus- 
trations have  been  added.  The  chapter  on  water  analysis  has  been  altered  to  correspond  with 
Wanklyn's  methods,  as  they  are  most  generally  used  in  America.  Several  other  processes  have 
been  added,  such  as  estimation  of  chloral  hydrate,  of  fat  in  milk,  etc.,  and  various  minor  changes 
in  arrangement  have  been  made  in  the  interest  of  convenience  in  using  the  treatise." — The 
Popular  Science  Alonthly. 

NAPHEYS'  Modem  Therapeutics.  Ninth  Revised  Edition,  Enlarged  and  Im- 
proved. In  Two  Handsome  Volumes.  Edited  by  Allen  J.  Smith,  m.d.,  Pro- 
fessor of  Pathology,  University  of  Texas,  Galveston,  late  Ass't  Demonstrator  of 
Morbid  Anatomy  and  Pathological  Histology,  Lecturer  on  Urinology,  University 
of  Pennsylvania;  and  J.  Aubrey  Davis,  m.d.,  Ass't  Demonstrator  of  Obstetrics, 
University  of  Pennsylvania;  Ass't  Physician  to  Home  for  Crippled  Children,  etc. 

Vol.  I. — General  Medicine  and  Diseases  of  Children. 

Handsome  Cloth  binding,  $4.00 

Vol.  II. — General  Surgery,  Obstetrics,  and  Diseases  of  Women. 

Handsome  Cloth  binding,  $4.00 

NEW  SYDENHAM  SOCIETY  Publications.  Three  to  Six  Volumes  published 
each  year.     List  of  Volumes  upon  application.  Per  annum,  $8.00 

OBERSTEINER.  The  Anatomy  of  the  Central  Nervous  Organs.  A  Guide  to  the 
study  of  their  structure  in  Health  and  Disease.  By  Professor  H.  Obersteiner, 
of  the  University  of  Vienna.  Translated  and  Edited  by  Alex.  Hill,  m.a.,  m.d., 
Master  of  Downing  College,  Cambridge.     198  Illustrations.     8vo.       Cloth,  55.50 

OPHTHALMIC  REVIEW.  A  Monthly  Record  of  Ophthalmic  Science.  Published 
in  London.     Sajnple  Numbers,  2^  cents.  Per  annum,  1:3.00 

ORMEROD.  Diseases  of  Nervous  System,  Student's  Guide  to.  By  J.  A.  Ormerod, 
m.d.  (Oxon.),  F.R.c.P.  (Lond.),  Mem.  Pnth.,  Clin.,  Ophth.,  and  Neurol.  Societies, 
Physician  to  National  Hospital  for  Paralyzed  and  Epileptic  and  to  City  of  London 
Hospital  for  Diseases  of  the  Chest,  Dem.  of  Morbid  Anatomy,  St.  Bartholo 
mew's  Hospital,  etc.     With  75  Wood  Engravings.     i2mo.  Cloth,  $1.00 

OSGOOD.    The  Winter  and  Its  Dangers.    By  Hamilton  Osgood,  m.d.  Cloth,  .40 

OSLER.  Cerebral  Palsies  of  Children.  A  Clinical  Studv.  By  William  Osler, 
m.d.,  F.R.c.P.  (Lond.),  Professor  of  Medicine,  Johns  Hopkins  University,  etc. 
8vo.  Cloth,  Ji2.oo 

Chorea  and  Choreiform  Affections.    8vo.  Cloth,  $2.00 


20  P.  BLAKISTON,  SON  &-  CO:S 

OSTROM.  Massage  and  the  Original  Swedish  Movements.  Their  Application 
to  Various  Diseases  of  the  Body.  A  Manual  for  Students,  Nurses  and  Physicians. 
By  KuRRE  W.  OsTROM,  from  the  Royal  University  of  Upsala,  Sweden;  Instructor 
in  Massage  and  Swedish  Movements  in  the  Hospital  of  the  University  of 
Pennsylvania,  and  in  the  Philadelphia  Polyclinic  and  College  for  Graduates  in 
Medicine,  etc.  Third  Edition.  Enlarged.  Illustrated  by  94  Wood  Engrav- 
ings, many  of  which  were  drawn  especially  for  this  purpose.    i2mo.     Cloth,  $1.00 

OVERMAN'S  Practical  Mineralogy,  Assaying  and  Mining,  with  a  Description  of 
the  Useful  Minerals,  etc.  By  Frederick  Overman,  Mining  Engineer.  Elev- 
enth Edition.     i2mo.  Cloth,  $1.00 

PACKARD'S  Sea  Air  and  Sea  Bathing.    By  John  H.  Packard,  m.d.     Cloth,  .40 

PAGE.     Railroad  Injuries.     With  Special  Reference  to  those  of  the   Back  and 

Nervous  System.     By  Herbert  Page,  f.r.c.s.,  Surgeon  to  St.  Mary's  Hospital, 

•  and  Lecturer  on  Surgery  at  its  Medical  School.     Octavo.  Cloth,  $2.25 

Injuries  of  the  Spine  and  Spinal  Cord.     In  their  Surgical  and  Medico-Legal 

Aspects.     Third  Edition.     Revised.     Octavo.  Preparing. 

PARKES'  Practical  Hygiene.  By  Edward  A.  Parkes,  m.d.  The  Eighth  Re- 
vised and  Enlarged  Edition.  Edited  by  J.  Lane  Notter,  m.a.,  m.d.,  f.c.S., 
Professor  of  Hygiene,  Army  Medical  School,  Netley,  England.  With  10  Litho- 
graphic Plates  and  over  100  other  Illustrations.     8vo.  Cloth,  $4.50 

PARKES.     Hygiene  and  Public  Health.     A  Practical  Manual.     By  Louis  C. 

Parkes,  m.d.,  d.p.h.  London  Hospital;  Assistant  Professor   of  Hygiene   and 

Pubhc  Health  at  University  College,  etc.     i2mo.     Fourth  Edition,  Enlarged  and 

Revised.  .  Cloth,  $2.50 

Popular  Hygiene.     The  Elements  of  Health.     A  Book  for  Lay  Readers. 

Illustrated.  Cloth,  $1.25 

PARRISH'S  Alcoholic  Inebriety.  From  a  Medical  Standpoint,  with  Illustrative 
Cases  from  the  Clinical  Records  of  the  Author.  By  Joseph  Parrish,  m.d., 
President  of  the  Amer.  Assoc,  for  Cure  of  Inebriates.  Cloth,  $1.00 

PARVIN'S  Winckel's  Diseases  of  Women.    (See  Winckel,  page  28.) 

PHILLIPS.  Spectacles  and  Eyeglasses,  Their  Prescription  and  Adjustment.  By 
R.  J.  Phillips,  m.d..  Instructor  on  Diseases  of  the  Eye,  Philadelphia  Polyclinic, 
Ophthalmic  Surgeon,  Presbyterian  Hospital.  Second  Edition,  Revised.  47 
Illustrations.     i2mo.  In  Press. 

PHYSICIAN'S  VISITING  LIST.  Published  Annually.  Forty-fifth  Year  (1896) 
of  its  Publication. 

Hereafter  all  styles  will  contain  the  interleaf  or  special  memoranda  page,  except 
the  Monthly  Edition,  and  the  sizes  for  75  and  100  Patients  will  come  in  two  volumes 
only.     Send  for  new  circular  describing  improvements. 

KEGULAR  EDITION". 

For  25  Patients  weekly.  Tucks,  pocket  and  pencil,  Gilt  Edges,  jgi.oo 

50         "           '<                                                "  ."  "         "         "          1.25 

i<          1  (Jan.  to  June]  ,.  .,                   ,,         ,,         ,,          _  .^ 

50                    "2  vols.  IJuiyto'Dec.}  ""^ 

<<          1  I  Jan.  to  June  (  ,,  ,.                   ,,         ,,         ,,          _  ^^ 

75  "2  vols.  jj^iytoDec.} 

,,          1  f  Jan.  to  June  ]  .,  ,,                   ,,         .,         ,,          ^  ^p 

,^°°                      ^^°1^-  1  July  to  Dec.  I  "-^5 


MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  21 

Perpetual  Edition,  without  Dates  and  with  Special   Memorandum    Pages. 
For  25  Patients,  interleaved,  tucks,  pocket  and  pencil,  ....         $1.25 

50         "  "  .......  ....  1.50 

Monthly  Edition,  without  Dates.    Can  be  commenced  at  any  time  and  used 

until  full.    Requires  only  one  writing  of  patient's  name  for  the  whole  month. 

Plain  binding,  without  Flap  or  Pencil,  .75.      Leather  cover.  Pocket  and  Pencil,  $1.00 

EXTKA  Pencils  will  be  sent,  postpaid,  for  25  cents  per  half  dozen. 

Ji^*  This  List  combines  the  several  essential  qualities  of  strength,  compactness, 

durability  and  convenience.    It  is  made  in  all  sizes  and  styles  to  meet  the  wants  of  all 

physicians.     It  is  not  an  elaborate,  complicated  system  of  keeping  accounts,  but  a 

plain,  simple  record,  that  may  be  kept  with  the  least  expenditure  of  time  and  trouble — 

hence  its  popularity.    A  special  circular,  descriptive  of  contents  and  improvements, 

will  be  sent  upon  application. 

PEREIRA'S  Prescription  Book.  Containing  Lists  of  Terms,  Phrases,  Contrac- 
tions and  Abbreviations  used  in  Prescriptions,  Explanatory  Notes,  Grammatical 
Construction  of  Prescriptions,  Rules  for  the  Pronunciation  of  Pharmaceutical 
Terms.    By  Jonathan  Pereira,  m.d.    Sixteenth  Edition.    Cloth,  .75;  Tucks  $1.00 

PORTER'S  Surgeon's  Pocket-Book.  By  Surgeon-Major  J.  H.  Porter,  late  Pro- 
fessor of  Military  Surgery  in  the  Army  Medical  School,  Netley,  England.  Revised, 
and  partly  Rewritten.     Third  Edition.     Small  i2mo.  Leather  Covers,  $2.00 

POTTER.  A  Handbook  of  Materia  Medica,  Pharmacy  and  Therapeutics,  in- 
cluding the  Action  of  Medicines,  Special  Therapeutics,  Pharmacology,  etc.  In- 
cluding over  600  Prescriptions  and  Formulse.  By  Samuel  O.  L.  Potter,  m.a., 
M.D.,  m.r.c.p.  (Lond.),  Professor  of  the  Practice  of  Medicine,  Cooper  Medical  Col- 
lege, San  Francisco;  late  A.  A.  Surgeon  U.S.  Army.  Fifth  Edition,  Revised  and 
Enlarged.    8vo.     With  Thu7nb  Index  in  each  copy.     Cloth,  $4.00;  Leather,  $5.00 

Compend  of  Anatomy,  including  Visceral  Anatomy.  Fifth  Edition.  Re- 
vised, and  greatly  Enlarged.  With  16  Lithographed  Plates  and  117  other 
Illustrations.     Being  No.  i  ?  Quiz-  Compend  ?  Series. 

Cloth,  .80;  Interleaved  for  taking  Notes,  $1.25 

Compend  of  Materia  Medica,  Therapeutics  and  Prescription  Writing, 

with  special  reference  to  the  Physiological  Action  of  Drugs.  Sixth  Revised 
and  Improved  Edition,  with  Index,  based  upon  U.  S.  P.  1890.  Being  No. 
6  f  Quiz- Compend?  Series.  Cloth,  .80.  Interleaved  for  taking  Notes,  $1.25 
Speech  and  Its  Defects,  Considered  Physiologically,  Pathologically  and 
Remedially;  being  the  Lea  Prize  Thesis  of  Jefferson  Medical  College,  1882. 
Revised  and  Corrected.     i2mo.  Cloth,  JSi.oo 

POWELL.    Diseases  of  the  Lungs  and  Pleurae,  Including  Consumption.    By 

R.  Douglas  Powell,  m.d.,  f.r.c.p.,  Physician  to  the  Middlesex  Hospital,  and 
Consulting  Physician  to  the  Hospital  for  Consumption  and  Diseases  of  the  Chest 
at  Brompton,  Fourth  Edition.  With  Colored  Plates  and  Wood  Engravings. 
8vo.  Cloth,  $4.00 

POWER.  Surgical  Diseases  of  Children  and  their  Treatment  by  Modern 
Methods.  By  D'Arcy  Power,  m.a.,  f.r.c.s.  Eng.,  Demonstrator  of  Operative 
Surgery,  St.  Bartholomew's  Hospital;  Surgeon  to  the  Victoria  Hospital.  Illus- 
trated.    i2mo.  Cloth,  $2.50 

PRITCHARD  on  the  Ear.  Handbook  of  Diseases  of  the  Ear.  By  Urban 
Pritchard,  m.d.,  f.r.c.s. .Professor  of  Aural  Surgery,  King's  College,  London, 
Aural  Surgeon  to  King's  College  Hospital,  Senior  Surgeon  to  the  Royal  Ear  Hos- 
pital, etc.    Second  Edition.    Many  Illustrations  and  Formulas.   i2mo.  Cloth,  $\.i^ 

PROCTOR'S  Practical  Pharmacy.  Lectures  on  Practical  Pharmacy.  With  Wood 
Engravings  and  32  Lithographic  Fac-simile  Prescriptions.  By  Barnard  S. 
Proctor.  Third  Edition.  Revised  and  with  elaborate  Tables  of  Chemical 
Solubilities,  etc.  Cloth,  3t3.co 


22  P.  BLAKISTON,  SON  <S-  CO:S 

RALFE.  Diseases  of  the  Kidney  and  Urinary  Derangements.  By  C.  H.  Ralfe, 
M.D.,  F.R.C.P.,  Ass't  Physician  to  the  London  Hospital.    lUus.    i2mo.    Cloth,  $2.00 

RAMSAY.  A  System  of  Inorganic  Chemistry.  By  William  Ramsay,  ph.d,, 
F.R.S.,  Prof,  of  Chem.  in  University  College,  London.    Illus.     8vo.     Cloth,  $4.00 

REESE'S  Medical  Jurisprudence  and  Toxicology.  A  Text-book  for  Medical  and 
Legal  Practitioners  and  Students.  By  John  J.  Reese,  m.d..  Editor  of  Taylor's 
Jurisprudence,  Professor  of  the  Principles  and  Practice  of  Medical  Jurisprudence, 
including  Toxicology,  in  the  University  of  Pennsylvania  Medical  Department. 
Fourth  Edition.  Revised  by  Henry  Leffmann,  m.d.,  Pathological  Chemist, 
Jefferson  Medical  College  Hospital,  etc.     i2mo.     624  pages. 

Cloth,  $3.00;   Leather,  $3.50 
"  To  the  student  of  medical  jurisprudence  and  toxicology  it  is  invaluable,  as  it  is  concise, 

clear,  and  thorough  in  every  respect." — The  American  Journal  of  the  Medical  Sciences. 

REEVES.  Medical  Microscopy.  Illustrated.  A  Handbook  for  Physicians  and 
Students,  including  Chapters  on  Bacteriology,  Neoplasms,  Urinary  Examination, 
etc.  By  James  E.  Reeves,  m.d.,  Ex-President  American  Pubhc  Health  Associa- 
tion, Member  Association  American  Physicians,  etc.  Numerous  Illustrations, 
some  of  which  are  printed  in  colors.  i2mo.     Handsome  Cloth,  $2.50 

REEVES.  Bodily  Deformities  and  their  Treatment.  A  Handbook  of  Practical 
Orthopaedics.  By  H.  A.  Reeves,  m.d..  Senior  Ass't  Surgeon  to  the  London  Hos- 
pital, Surgeon  to  the  Royal  Orthopsedic  Hospital.     228  Illustrations.     Cloth,  $1.75 

REGIS.  Mental  Medicine.  A  Practical  Manual.  By  Dr.  E.  Regis,  formerly 
Chief  of  Clinique  of  Mental  Diseases,  Faculty  of  Medicine  of  Paris  ;  Physician 
of  the  Maison  de  Sante  de  Castel  d'Andorte  ;  Professor  of  Mental  Diseases, 
Faculty  of  Medicine,  Bordeaux,  etc.  With  a  Preface  by  M.  Benjamin  Ball, 
Clinical  Professor  of  Mental  Diseases,  Faculty  of  Medicine,  Paris.  Authorized 
Translation  from  the  Second  Edition  by  H.  M.  Bannister,  m.d.,  late  Senior 
Assistant  Physician,  Illinois  Eastern  Hospital  for  the  Insane,  etc.  With  an  In- 
troduction by  the  Author.     i2mo.     692  pages.  Cloth,  $2.00 

RICHARDSON.  Long  Life,  and  How  to  Reach  It.  By  J.  G.  Richardson,  Prof, 
of  Hygiene,  University  of  Pennsylvania.  Cloth,  .40 

RICHARDSON'S  Mechanical  Dentistry.  A  Practical  Treatise  on  Mechanical 
Dentistry.  By  Joseph  Richardson,  d.d.s.  Sixth  Edition.  Thoroughly  Revised 
by  Dr.  Geo.  W.  Warren,  Chief  of  the  Clinical  Staff,  Pennsylvania  College  of 
Dental  Surgery,  Phila.   With  600  Illustrations.    Bvo.    Cloth,  $4.00 ;  Leather,  #5.00 

RICHTER'S  Inorganic  Chemistry.    A  Text-book  for  Students.    By  Prof.  Victor 

VON   RiCHTER,   University  of  Breslau.     Fourth  American,  from  Sixth  German 

Edition.      Authorized   Translation   by  Edgar  F.  Smith,  m.a.,  ph.d.,  Prof,  of 

Chemistry,  University  of  Pennsylvania,  Member  of  the  Chemical  Societies  of 

Berlin  and  Paris.    89  Illustrations  and  a  Colored  Plate.     i2mo.  Cloth,  $1.75 

Organic  Chemistry.     The  Chemistry  of  the  Carbon  Compounds.     Second 

American  Edition,  translated  from  the  Sixth  German  by  Edgar  F.  Smith, 

m.  a.,  ph.  d..  Professor  of  Chemistry,  University  of  Pennsylvania.    Illustrated. 

1040  pages.     i2mo.  Cloth,  14,50 

ROBERTS.  Practice  of  Medicine.  The  Theory  and  Practice  of  Medicine.  By 
Frederick  Roberts,  m.d..  Professor  of  Therapeutics  at  University  College, 
London.    Ninth  Edition,  with  Illustrations.    8vo.        Cloth,  $4.50;  Leather,  $5.50 

ROBINSON.  Latin  Grammar  of  Pharmacy  and  Medicine  By  D.  H.  Robinson, 
PH.D.,  Professor  of  Latin  Language  and  Literature,  University  of  Kansas.  Intro- 
duction by  L.  E.  Sayre,  ph.g.,  Professor  of  Pharmacy  in,  and  Dean  of  the  Dept. 
of  Pharmacy,  University  of  Kansas.     i2mo.     Second  Edition.  Cloth,  $1.75 


MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  23 

SCOVILLE.  The  Art  of  Compounding.  A  Text-book  for  Students  and  a  Refer- 
ence Book  for  Pharmacists.  By  Wilbur  L.  Scoville,  ph.g.,  Professor  of  Ap- 
plied Pharmacy  and  Director  of  the  Pharmaceutical  Laboratory  in  the  Massa- 
chusetts College  of  Pharmacy.  Nearly  Ready. 

SANSOM.  Diseases  of  The  Heart.  The  Diagnosis  and  Pathology  of  Diseases  of 
the  Heart  and  Thoracic  Aorta.  By  A.  Ernest  Sansom,  m.d.,  f.r.c.p.,  Physician 
to  the  London  Hospital,  Examiner  in  Medicine  Royal  College  of  Physicians,  etc. 
With  Plates  and  other  Illustrations.     8vo.  Cloth,  $6.00 

SAYRE.  Organic  Materia  Medica  and  Pharmacognosy.  An  Introduction 
to  the  Study  of  the  Vegetable  Kingdom  and  the  Vegetable  and  Animal  Drugs. 
Comprising  the  Botanical  and  Physical  Characteristics,  Source,  Constituents,  and 
Pharmacopoeial  Preparations.  With  Chapters  on  Synthetic  Organic  Remedies, 
Insects  Injurious  to  Drugs,  and  Pharmacal  Botany.  By  L.  E.  Sayre,  ph.g., 
Professor  of  Pharmacy  and  Materia  Medica  in  the  University  of  Kansas,  Mem- 
ber of  the  Committee  of  Revision  of  the  U.S.  Pharmacopoeia,  1890.  A  Glossary 
and  543  Illustrations,  many  of  which  are  original.     8vo.  Cloth,  $4.00 

SCHTJLTZE.  Obstetrical  Diagrams.  Being  a  Series  of  20  Colored  Lithograph 
Charts,  imperial  map  size,  of  Pregnancy  and  Midwifery,  with  accompanymg 
explanatory  (German)  text,  illustrated  by  wood-cuts.  By  Dr.  B.  S.  Schultze, 
Professor  of  Obstetrics,  University  of  Jena.     Second  Revised  Edition. 

Price,  in  Sheets,  $26.00 ;  Mounted  on  Rollers,  Muslin  Backs,  $36.00 

SEWELL.  Dental  Surgery,  including  Special  Anatomy  and  Surgery.  By  Henry 
Sewell,  M.R.C.S.,  L.D.S.,  President  Odontological  Society  of  Great  Britain.  3d 
Edition,  greatly  enlarged,  with  about  200  Illustrations.  Cloth,  $2.00 

SHAWE.  Notes  for  Visiting  Nurses,  and  all  those  interested  in  the  working  and 
organization  of  District,  Visiting,  or  Parochial  Nurse  Societies.  By  Rosilind 
Gillette  Shawe,  District  Nurse  for  the  Brooklyn  Red  Cross  Society.  With  an 
Appendix  explaining  the  organization  and  working  of  various  Visiting  and  Dis- 
trict Nurse  Societies,  by  Helen  C.  Jenks,  of  Philadelphia.    i2mo.    Cloth,  $1.00 

SMITH.  Abdominal  Surgery.  Being  a  Systematic  Description  of  all  the  Princi- 
pal Operations.  By  J.  Greig  Smith,  m.a.,  f.r.s.e.,  Surg,  to  British  Royal  In- 
firmary ;  Lecturer  on  Surgery,  Bristol  Medical  School ;  Late  Examiner  in  Surgery, 
University  of  Aberdeen,  etc.    Over  80  Illustrations.    Fourth  Edition.    Cloth,  $6.00 

SMITH.  Electro-Chemical  Analysis.  By  Edgar  F.  Smith,  Professor  of  Chem- 
istry, University  of  Pennsylvania.  Second  Edition,  Revised  and  Enlarged.  28 
Illustrations.     i2mo.  Cloth,  $1.25 

SMITH  AND  KELLER.  Experiments.  Arranged  for  Students  in  General  Chem- 
istry. By  Edgar  F.  Smith,  Professor  of  Chemistry,  University  of  Pennsylvania, 
and  Dr.  H.  F.  Keller,  Professor  of  Chemistry,  Philadelphia  High  School.  Sec- 
ond Edition.     8vo.     Illustrated.  Cloth,  .60 

STARR.  The  Digestive  Organs  in  Childhood.  Second  Edition.  The  Diseases 
of  the  Digestive  Organs  in  Infancy  and  Childhood.  With  Chapters  on  the 
Investigation  of  Disease  and  the  Management  of  Children.  By  Louis  Starr, 
M.D.,  late  Clinical  Prof,  of  Diseases  of  Children  in  the  Hospital  of  the  University 
of  Penn'a;  Physician  to  the  Children's  Hospital,  Phila.  Second  Edition. 
Revised  and  Enlarged.  Illustrated  by  two  Colored  Lithograph  Plates  and 
numerous  Wood  Engravings.     Crown  Octavo.  Cloth,  $2.00 

The  Hygiene  of  the  Nursery,  including  the  General  Regimen  and  Feed- 
ing of  Infants  and  Children,  and  the  Domestic  Management  of  the  Ordinary 
Emergencies  of  Early  Life,  Massage,  etc.  Fourth  Edition.  Enlarged.  25 
Illustrations.     i2mo.     280  pages.  Cloth,  Ji.oo 

See  also  Goodhart  and  Starr,    Page  11. 


24  P.  BLAKISTON,  SON  &-  CO:S 

STAMMER.  Chemical  Problems,  with  Explanations  and  Answers.  By  Karl 
Stammer.  Translated  from  the  Second  German  Edition,  by  Prof.  W.  S.  Hos- 
KINSON,  A.M.,  Wittenberg  College,  Springfield,  Ohio.     i2mo.  Cloth.  .50 

STARLING.  Elements  of  Human  Physiology.  By  Ernest  H.  Starling,  m.d. 
LoND.,  M.R.C.P.,  Joint  Lecturer  on  Physiology  at  Guy's  Hospital,  London ; 
Member  of  Physiological  Society,  etc.  With  100  Illustrations.  i2mo.  437 
pages.  Cloth,  $1.00 

STEARNS.  Mental  Diseases.  Lectures  on  Mental  Diseases,  designed  especially  for 
Medical  Students  and  General  Practitioners.  By  Henry  Putnam  Stearns,  m.d., 
Physician  Superintendent  at  the  Hartford  Retreat,  Lecturer  on  Mental  Diseases 
in  Yale  University,  Member  of  the  American  Medico-Psychological  Ass'n,  Hon- 
orary Member  of  the  Boston  Medico-Pyschological  Society.  With  a  Digest  of 
Laws  of  the  Various  States  Relating  to  Care  of  Insane.  Illustrated.  JVew  Series 
of  Manuals.  Cloth,  $2.75  ;  Sheep,  $3.25 

STEAVENSON  AND  JONES.  Medical  Electricity.  A  Pracdcal  Handbook  for 
Students  and  Practitioners  of  Medicine.  By  W.  E.  Steavenson,  m.d.,  late  in 
charge  Electrical  Department,  St.  Bartholomew's  Hospital,  and  H.  Lewis  Jones, 
M.A.,  M.D.,  M.R.C.P.,  Medical  Officer  in  Charge  Electrical  Department,  St.  Bar- 
tholomew's Hospital.     Second  Edition.     103  Illustrations.     i2mo.        Preparing. 

STEVENSON  AND  MURPHY.    A  Treatise  on  Hygiene.    By  Various  Authors. 
Edited  by  Thomas  Stevenson,  m.d.,  f.r.c.p..  Lecturer  on  Chemistry  and  Medi- 
cal Jurisprudence  at  Guy's    Hospital,  London,  etc.,  and  Shirley  F.  Murphy, 
Medical  Officer  of  Health  to  the  County  of  London.    In  Three  Octavo  Volumes. 
Vol.  I.    With  Plates  and  Wood  Engravings.   Octavo.  Cloth,  $6.00 

Vol.  II.     With  Plates  and  Wood  Engravings.     Octavo.  Cloth,  $6.00 

Vol.  III.    Just  Ready.  Cloth,  $5.00 

***  Special  Circular  upon  application. 

STEWART'S  Compend  of  Pharmacy.  Based  upon  "  Remington's  Text-Book  of 
Pharmacy."  By  F.  E.  Stewart,  m.d.,  ph. g..  Quiz  Master  in  Chem.  and  Theoreti- 
cal Pharmacy,  Phila.  College  of  Pharmacy ;  Lect.  in  Pharmacology,  Jefferson 
Medical  College.  Fifth  Ed.  Revised  in  accordance  with  U.  S.  P.,  1890.  Com- 
plete tables  of  Metric  and  English  Weights  and  Measures,  f  Quiz- Compend f 
Series.  Cloth,  .80;  Interleaved  for  the  addition  of  notes,  ;?i. 25 

STIRLING.  Outlines  of  Practical  Physiology.  Including  Chemical  and  Experi- 
mental Physiology,  with  Special  Reference  to  Practical  Medicine.  By  W.  Stir- 
ling, m.d.,  Sc.d.,  Prof,  of  Phys.,  Owens  College,  Victoria  University,  Manchester. 
Examiner  in  Honors  School  of  Science,  Oxford,  England.  Third  Edition. 
234  Illustrations.  In  Press. 

Outlines  of  Practical  Histology.     368  Illustrations.     Second  Edition.     Re- 
vised and  Enlarged  with  new  Illustrations.     i2mo.  Cloth,  $2.00 

STRAHAN.  Extra-Uterine  Pregnancy.  The  Diagnosis  and  Treatment  of  Extra- 
Uterine  Pregnancy.  Being  the  Jenks  Prize  Essay  of  the  College  of  Physicians 
of  Philadelphia.  By  John  Strahan,  m.d.  (Univ.  of  Ireland),  late  Res.  Surgeon 
Belfast  Union  Infirmary  and  Fever  Hospital.     Octavo.  Cloth,  .75 

SWANZY.  Diseases  of  the  Eye  and  their  Treatment.  A  Handbook  for  Physi- 
cians and  Students.  By  Henry  R.  Swanzy,  a.m.,  m.b.,  f.r.c.s.i..  Surgeon  to 
the  National  Eye  and  Ear  Infirmary  ;  Ophthalmic  Surgeon  to  the  Adelaide  Hos- 
pital, Dublin.  Fourth  Edition,  Thoroughly  Revised.  Enlarged.  164  Illustra- 
tions. Two  Colored  and  one  Plain  Plate,  and  a  Zephyr  Test  Card.  i2mo. 
New  Series  of  Manuals.  Cloth,  $2.50;  Sheep,  $3.00 


MEDICAL  AND  SCIENTIFIC  PUBLICATIONS.  25 

SUTTON'S  Volumetric  Analysis.  A  Systematic  Handbook  for  the  Quantitative 
Estimation  of  Chemical  Substances  by  Measure,  Applied  to  Liquids,  Solids  and 
Gases.  By  Francis  Sutton,  f.c.s.  Sixth  Edition,  Revised  and  Enlarged, 
with  Illustrations.     8vo.  Cloth,  $4.50 

SYMONDS.  Manual  of  Chemistry,  for  Medical  Students.  By  Brandreth 
Symonds,  a.m.,  M.D.,  Ass't  Physician  Roosevelt  Hospital,  Out-Patient  Department ; 
Attending  Physician  Northwestern  Dispensary,  New  York.  Second  Edition. 
i2mo.  Cloth,  $2.00 

TAFT'S  Operative  Dentistry.  A  Practical  Treatise  on  Operative  Dentistry.  By 
Jonathan  Taft,  d.d.s.  Fourth  Revised  and  Enlarged  Edition.  Over  100  Il- 
lustrations.    8vo.  Cloth,  $3.00  ;  Leather,  $4.00 

Index  of  Dental  Periodical  Literature.    8vo,  Cloth,  $2.00 

TALBOT.  Irregularities  of  the  Teeth,  and  Their  Treatment.  By  Eugene  S. 
Talbot,  m.d..  Professor  of  Dental  Surgery  Woman's  Medical  College,  and 
Lecturer  on  Dental  Pathology  in  Rush  Medical  College,  Chicago.  Second  Edi- 
tion, Revised  and  Enlarged  by  about  100  pages.  Octavo.  234  Illustrations 
(169  of  which  are  original).     261  pages.  Cloth,  $3.00 

TANNER'S  Memoranda  of  Poisons  and  their  Antidotes  and  Tests.  By  Thos. 
Hawkes  Tanner,  m.d.,  f.r.c.p.  7th  American,  from  the  Last  London  Edition. 
Revised  by  John  J.  Reese,  m.d..  Professor  Medical  Jurisprudence  and  Toxi- 
cology in  the  University  of  Pennsylvania.     i2mo.  Cloth,  .75 

TAYLOE.  Practice  of  Medicine.  A  Manual.  By  Frederick  Taylor,  m.d.. 
Physician  to,  and  Lecturer  on  Medicine  at,  Guy's  Hospital,  London  ;  Physician  to 
Evelina  Hospital  for  Sick  Children,  and  Examiner  in  Materia  Medica  and  Phar- 
maceutical Chemistry,  University  of  London.  Cloth,  $2.00;  Sheep,  $2.50 

TEMPERATURE  Charts  for  Recording  Temperature,  Respiration,  Pulse,  Day  of 
Disease,  Date,  Age,  Sex,  Occupation,  Name,  etc.  Put  up  in  pads;  each  .50 

THOMPSON.  Urinary  Organs.  Diseases  of  the  Urinary  Organs.  Containing  32 
Lectures.  By  Sir  Henry  Thompson,  f.r.c.s.,  Emeritus  Professor  of  Clinical  Sur- 
gery in  University  College.  Eighth  London  Ed.  Octavo.  470  pages.    Cloth,  $3.co 

Calculous  Diseases.     The  Preventive  Treatment  of  Calculous  Disease,  and 
the  Use  of  Solvent  Remedies.     Third  Edition.        i6mo.  Cloth,  .75 

THORBURN.  Surgery  of  the  Spinal  Cord.  A  Contribution  to  the  study  of.  By 
William  Thorburn,  b.Sc,  m.d.     Illustrated.     Octavo.  Cloth,  $4.00 

THORNTON.  The  Surgery  of  the  Kidney.  By  John  Knowsley  Thornton. 
M.B.  Edin.     With  19  Illustrations.  Cloth,  $1.50 

TOMES'  Dental  Anatomy.    A  Manual  of  Dental  Anatomy,  Human  and  Compara- 
tive.    By  C.  S.  Tomes,  d.d.s.     235  Illustrations.     4lh  Ed.     i2mo.     Cloth,  $3.50 
Dental  Surgery.    A  System  of   Dental  Surgery.    By  John  Tomes,  f.r.s. 
Third  Edition,  Revised   and   Enlarged.      By  C.  S.  Tomes,   d.d.s.      With 
292  Illustrations.     i2mo.     772  pages.  Cloth,  $4.00 

TRANSACTIONS  of  the  College  of  Physicians  of  Philadelphia.  Third  Series. 
Vols.  I,  II,  III,  IV,  V,  Cloth,  each.  $2.50.  VI,  VII,  Cloth,  each,  $1.^0.  Vol. 
VIII,  1886,  Cloth,  $3.75.     Vol.  IX,  Cloth,  $2.50. 

TRANSACTIONS  of  the  Association  of  American  Physicians.  Vols.  I  and  II, 
Cloth,  ^52. 50  each.  Vol.  Ill,  Cloth,  $-},.^o.  Vol.  IV,  Cloth,  33.00.  Vol.  V,  Cloth,  $2.50. 
Vol.  VI,  $3.00. 


26  P.  BLAKISTON,  SON  &-  CO:S 

TREVES.  German-Englisli  Medical  Dictionary.    By  Frederick  Treves,  f.r.c.s., 

assisted  by  Dr.  Hugo  Lang,  b.a.  (Munich).     i2mo.  %,  Russia,  $3.25 

Physical  Education,  Its  Elffects,  Value,  Methods,  etc.  Cloth,  .75 

TRIMBLE.  Practical  and  Analytical  Chemistry.  Being  a  complete  course  in 
Chemical  Analysis,  By  Henry  Trimble,  ph.m.,  Professor  of  Analytical  Chem- 
istry in  the  Philadelphia  College  of  Pharmacy.  Fourth  Edition.  Enlarged. 
Illustrated.     8vo.  Cloth,  $1.50 

TUKE.  Dictionary  of  Psychological  Medicine.  Giving  the  Definition,  Ety- 
mology, and  Synonyms  of  the  terms  used  m  Medical  Psychology,  with  the 
Symptoms,  Pathology,  and  Treatment  of  the  recognized  forms  of  Mental  Dis- 
orders, together  with  the  Law  of  Lunacy  in  Great  Britain  and  Ireland,  Edited  by 
D.  Hack  Tuke,  m.d.,ll.d..  Examiner  in  Mental  Physiology  in  the  University 
of  London.     Two  Volumes.     Octavo.  Cloth,  $10,00 

TURNBXJLL'S  Artificial  Anaesthesia.  The  Advantages  and  Accidents  of  Artifi- 
cial Anesthesia  ;  Its  Employment  in  the  Treatment  of  Disease  ;  Modes  of  Ad- 
ministration ;  Considering  their  Relative  Risks ;  Tests  of  Purity ;  Treatment  of 
Asphyxia;  Spasms  of  the  Glottis;  Syncope,  etc.  By  Laurence  Turnbull,  m.d., 
PH.  G.,  Aural  Surgeon  to  Jefferson  College  Hospital,  etc.  Third  Edition,  Re- 
vised and  Enlarged.  40  Illustrations.  i2mo.  Cloth,  $3.00 
TUSON.  Veterinary  Pharmacopoeia,  including  the  outlines  of  Materia  Medica 
and  Therapeutics.  By  Richard  V.  TusoN,  late  Professor  at  the  Royal  Veter- 
inary College.  Fifth  Edition.  Revised  and  Edited  by  James  Bayne,  f.c.s., 
Professor  of  Chemistry  and  Toxicology  at  the  Royal  Veterinary  College.     i2mo. 

Cloth,  $2.25 

TYSON.    Brig-ht's  Disease  and  Diabetes.    With  Especial  Reference  to  Pathology 

and  Therapeutics.     By  James  Tyson,  m.d.,  Professor  of  Clinical  Medicine  in 

the  University  of  Pennsylvania.     Including  a  Section  on  Retinitis  in  Bright's 

Disease.    With  Colored  Plates  and  many  Wood  Engravings.    8vo.     Cloth,  $2.50 

Guide  to  the  Examination  of  Urine.     Eighth  Edition.     For  the  Use  of 

Physicians  and  Students.    With  Colored  Plate  and  Numerous  Illustrations 

Engraved  on  Wood.  Eighth  Edition.  Revised.  i2mo.  272pages.   Cloth, $1.25 

Cell  Doctrine.    Its  History  and  Present  State.     Second  Edition.     Cloth,  $1.50 

Handbook  of  Physical  Diagnosis.    Illustrated.    2d  Ed.    i2mo.    Cloth,  $1.25 

UNITED  STATES  PHARMACOPffilA.  1890.  Seventh  Decennial  Revision, 
Cloth,  $2.50  (Postpaid,  $2.77);  Sheep,  $3.00  (Postpaid,  $3.27);  Interleaved, 
$4.00  (Postpaid,  $4.50);  printed  on  one  side  of  page  only.  Unbound,  $3.50  (Post- 
paid, $3.90). 

Select  Tables  from  the  U.  S.  P.  (1890).  Being  Nine  of  the  Most  Important 
and  Useful  Tables,  printed  on  Separate  Sheets.  Carefully  put  up  in  Patent 
Envelope.  .25 

VAN  HARLINGEN  on  Skin  Diseases.    A  Practical  Manual  of  Diagnosis  and 

Treatment.  By  Arthur  Van  Harlingen,  m.d..  Professor  of  Diseases  of  the 
Skin  in  the  Philadelphia  Polyclinic ;  Clinical  Lecturer  on  Dermatology  at  Jef- 
ferson Medical  College.  Third  Edition.  Revised  and  Enlarged.  With  Formulae 
and  many  Illustrations.  Nearly  Ready. 

VAN  NUYS  on  The  Urine.  Chemical  Analysis  of  Healthy  and  Diseased  Urine, 
Qualitative  and  Quantitative.  By  T.  C.  Van  NiJYS,  Professor  of  Chemistry 
Indiana  University.     39  Illustrations.     Octavo.  Cloth,  $1.00 

VIRCHOW'S  Post-mortem  Examinations.  A  Description  and  Explanation  of  the 
Method  of  Performing  them  in  the  Dead  House  of  the  Berlin  Charite  Hospital, 
with  especial  reference  to  Medico-legal  Practice.  By  Prof.  Virchow.  Trans- 
lated by  Dr.  T.  P.  Smith.     Third  Edition,  with  Additions,  Cloth,  .75 

VOSWINKEL.  Surgical  Nursing.  A  Manual  for  Nurses.  By  Bertha  M.  Vos- 
WINKEL,  Graduate  Episcopal  Hospital,  Philadelphia,  Nurse  in  Charge  Children's 
Hospital,  Columbus,  O.     1 11  Illustrations.    i2mo.     168  pages.  Cloth,  $1.00 


MEDICAL  AND  SCIENTIFIC  PUBLICA  TIONS.  27 

WALSHAM.  Manual  of  Practical  Surgery.  For  Students  and  Physicians.  By 
Wm.  J.  Walsham,  M.D.,  F.R.C.S.,  Ass't  Surg.  to,  and  Dem.  of  Practical  Surg,  in, 
St.  Bartholomew's  Hospital,  Surg,  to  Mietropolitan  Free  Hospital.  London. 
Fifth  Edition,  Revised  and  Enlarged.  With  380  Engravings.  815  pages. 
Nenv  Series  of  Manuals.  Cloth,  $2.75  ;  Leather,  1^3.25 

WARING.  Practical  Therapeutics.  A  Manual  for  Physicians  and  Students.  By 
Edward  J.  Waring,  m.d.  Fourth  Edition.  Revised,  Rewritten  and  Rearranged 
by  Dudley  W.  Buxton,  m.d..  Assistant  to  the  Professor  of  Medicine,  University 
College,  London.     Crown  Octavo.  Cloth,  $2.00 ;  Leather,  §3.00 

WARREN.  Compend  Dental  Pathology  and  Dental  Medicine.  Containing  all 
the  most  noteworthy  points  of  interest  to  the  Dental  Student  and  a  Chapter 
on  Emergencies.  By  Geo.  W.  "Warren,  d.d.s.,  Clinical  Chief,  Penn'a  College 
of  Dental  Surgery,  Phila.  Second  Edition,  Enlarged.  Illustrated.  Being  No. 
13  f  Quiz- Compend  f  Series.     i2mo.  Cloth,  .80 

Interleaved  for  the  addition  of  Notes,  $1.25 

Dental  Prostheses  and  Metallurgy.     129  Illustrations.  Cloth,  $1.25 

WATSON  on  Amputations  of  the  Extremities  and  Their  Complications.  By 
B.  A.  Watson,  a.m.,  m.d.,  Surgeon  to  the  Jersey  City  Charity  Hospital  and  to 
Christ's  Hospital,  Jersey  City,  N.  J.     250  Illustrations.  Cloth,  $5.50 

Concussions.  An  Experimental  Study  of  Lesions  arising  from  Severe  Con- 
cussions.    8vo.  Paper  cover,  5? 1. 00 

WATTS'  Inorganic  Chemistry.  A  Manual  of  Chemistry,  Physical  and  Inorganic. 
(Being  the  14th  Edition  of  Fowne's  Physical  and  Inorganic  Chemistry.) 
By  Henry  "Watts,  b.a.,  f.r.s.  With  Colored  Plate  of  Spectra  and  other  Illus- 
trations.    i2mo.     595  pages.  Cloth,  $2.00 

Organic  Chemistry.  Second  Edition.  By  Wm.  A.  Tilden,  d.sc,  f.r.s. 
(Being  the  13th  Edition  of  Fowne's  Organic  Chemistry.)  Illustrated. 
i2mo.  Cloth,  $2.00 

WELLS.  Compend  of  Gynecology.  By  Wm.  H.  Wells,  m.d..  Assistant  Demon- 
strator of  Obstetrics,  Jefferson  Medical  College,  Philadelphia.  Illustrated. 
f  Quiz- Compend  f  Series  No.  7.    i2mo.       Cloth,  .80 ;  Interleaved  for  Notes,  $1.25 

WESTLAND.  The  Wife  and  Mother.  A  Handbook  for  Mothers.  By  A. 
Westland,  m.d.,  late  Resident  Physician,  Aberdeen  Royal  Infirmary.   Clo.  |;r.5o 

WETHERED.  Medical  Microscopy.  A  Guide  to  the  Use  of  the  Microscope  in 
Practical  Medicine.  By  Frank  J.  Wethered,  m.d  ,  m.r.c.p..  Demonstrator  of 
Practical  Medicine,  Middlesex  Hospital  Medical  School,  Assistant  Physician, 
late  Pathologist,  City  of  London  Hospital  for  Diseases  of  Chest,  etc.  With  100 
Illustrations.     i2mo.  Cloth,  $2.00 

WEYL.  Sanitary  Relations  of  the  Coal-Tar  Colors.  By  Theodore  Weyl. 
Authorized  Translation  by  Henry  Leffmann,  m.d.,  ph.d.  This  work  contains 
the  most  recent  trustworthy  information  on  the  physiological  action  of  the  coal- 
tar  colors.  Tests  for  recognizing  the  different  colors  are  given.  A  summary  of 
the  appropriate  legislative  enactments  in  the  leading  countries  in  Europe  is  also 
presented.  The  book  is  believed  to  be  the  only  compilation  in  the  field  in 
English,  and  will  be  found  highly  useful  in  determining  the  permissibility  of  the 
coal-tar  colors,  now  so  much  used  in  articles  of  food  and  drink.  i2mo.  154 
pages.  Cloth,  $1.25 

WHITE.    The  Mouth  and  Teeth.     By  J.  W.  White,  m.d.,  d.d.s.  Cloth,  .40 


28  P.  BLAKISTON,  SON  &^  CO:S  PUBLICA  TIONS. 

WHITE  AND  WILCOX.  Materia  Medica,  Pharmacy,  Pharmacology,  and 
Therapeutics.  A  Handbook  for  Students.  By  W.  Hale  White,  m.d.,  f.r.c.p., 
etc.,  Physician  to  and  Lecturer  on  Materia  Medica,  Guy's  Hospital;  Examiner  in 
Materia  Medica,  Royal  College  of  Physicians,  London,  etc.  Second  American 
Edition.  Revised  by  Reynold  W.  Wilcox,  m.a.,  m.d.,  ll.d..  Professor  of  Clin- 
ical Medicine  and  Therapeutics  at  the  New  York  Post-Graduate  Medical  School 
and  Hospital ;  Visiting  Physician  St.  Mark's  Hospital ;  Assistant  Visiting  Physi- 
cian Bellevue  Hospital.     Second  Edition,  thoroughly  Revised.     i2mo. 

Cloth,  $2.75;  Leather,  $3.25 

WILSON.  Handbook  of  Hygiene  and  Sanitary  Science.  By  George  Wilson, 
M.A.,  M.D.,  F.R.S.E.,  Medical  Officer  of  Health  for  Mid-Warwickshire,  England. 
With  Illustrations.    Seventh  Edition,  Enlarged  by  200  pages.    i2mo.    Cloth,  $3.00 

WILSON.  The  Summer  and  its  Diseases.  By  James  C.  Wilson,  m.d.,  Prof,  of  the 
Practice  of  Med.  and  Clinical  Medicine,  Jefferson  Med.  Coll.,  Phila.     Cloth,  .40 

WILSON.  System  of  Human  Anatomy,  iifh  Revised  Edition.  Edited  by  Henry 
Edward  Clark,  m.d.,  m.r.c.s.  492  Illustrations,  26  Colored  Plates,  and  a 
Glossary  of  Terms.     Thick  i2mo.  Cloth,  $5.00 

WINCKEL.  Diseases  of  Women.  Second  Edition.  Including  the  Dis- 
eases of  the  Bladder  and  Urethra.  By  Dr.  F.  Winckel,  Professor  of 
Gynaecology,  and  Director  of  the  Royal  University  Clinic  for  Women,  in  Munich. 
Translated  by  special  authority  of  Author  and  Publisher,  under  the  supervision 
of,  and  with  an  Introduction  by,  Theophilus  Parvin,  m.d..  Professor  of 
Obstetrics  and  Diseases  of  Women  and  Children  in  Jefferson  Medical  Col- 
lege, Philadelphia.  With  152  Engravings  on  Wood,  most  of  which  are  original. 
2d  Edition,  Revised  and  Enlarged.  Cloth,  $3.00;  Leather,  $3.50 

"  Winckel's  hand-book  is  a  work  that  will  be  profitably  consulted  by  all  classes  of  gynecol- 
ogical practitioners.  It  contains  belter  and  more  elaborate  pathological  descriptions  than  any 
work  of  its  kind  in  the  English  language  that  we  are  acquainted  with.  ...  As  a  text-book 
for  students,  as  well  as  a  work  of  reference  for  the  practitioner,  we  can  conscientiously  recom- 
mend Winckel's  '  Diseases  of  Women.'  " — The  Medical  Record. 

Text-Book  of  Obstetrics ;  Including  the  Pathology  and  Therapeutics  of  the 
Puerperal  State.  Authorized  Translation  by  J.  Clifton  Edgar,  a.m.,  m.d., 
Adjunct  Professor  to  the  Chair  of  Obstetrics,  Medical  Department,  University 
City  of  New  York.  With  nearly  200  Handsome  Illus.,  the  majority  of  which 
are  original  with  this  work.     Octavo.  Cloth,  $5. 00;  Leather,  $6.00 

WOAKES.  Post-Nasal  Catarrh  and  Diseases  of  the  Nose,  causing  Deafness.  By 
Edward  Woakes,  m.d..  Senior  Aural  Surgeon  to  the  London  Hospital  for 
Diseases  of  the  Throat  and  Chest.     26  Illustrations.  Cloth,  $1.00 

WOOD.  Brain  Work  and  Overwork.  By  Prof.  H.  C.  Wood,  Clinical  Professor 
of  Nervous  Diseases,  University  of  Pennsylvania.     i2mo.  Cloth,  .40 

WOODY.  Essentials  of  Chemistry  and  Urinalysis.  By  Sam  E.  Woody,  a.m., 
M.D.,  Professor  of  Chemistry  and  Public  Hygiene,  and  Clinical  Lecturer  on 
Diseases  of  Children,  in  the  Kentucky  School  of  Medicine.  Fourth  Edition. 
Illustrated.     i2mo.  In  Press. 

WYTHE.  Dose  and  Symptom  Book.  The  Physician's  Pocket  Dose  and  Symptom 
Book.  Containing  the  Doses  and  Uses  of  all  the  Principal  Articles  of  the 
Materia  Medica,  and  Officinal  Preparations.  By  Joseph  H.  Wythe,  a.m.,  m.d. 
17th  Edition,  Revised.  Cloth,  .75;  Leather,  with  Tucks  and  Pocket,  $1.00 

YEO'S  Manual  of  Physiology.  Sixth  Edition.  A  Text-book  for  Students  of 
Medicine.  By  Gerald  F.  Yeo.,  m.d.,  f.r.c.s.,  Professor  of  Physiology  in  King's 
College,  London.  Sixth  Edition ;  revised  and  enlarged  by  the  author.  With 
254  Wood  Engravings  and  a  Glossary.  Crown  Octavo.  Being^  No.  4,  New 
Series  of  Manuals.  ,  Cloth,  $2.50;   Leather,  $3.00 


MORRIS'S 

HUMAN   ANATOMY. 

A   NEW  TEXT-BOOK. 

791  Illustrations,  214  of  which  are  Printed  in  Several  Colors,  and  most  of 
which  are  original.     OCTAVO.      1200  PAGES. 

Handsome  Cloth,  $6.00;   Full  Sheep,  $7.00;   Half  Russia, 
Marbled  Edges,  $8.00. 


j|@°"  We  will  send  free  to  any  address  a  large  descriptive  circular 
of  Morris's  Anatomy  giving  sample  pages  and  colored  illustrations,  as 
well  as  a  large  number  of  recommendations  from  prominent  professors 
and  demonstrators,  and  reviews  taken  from  the  best  medical  journals. 


"  The  treatise  on  '  Human  Anatomy  '  just  issued  from  the  press  of  Messrs. 
Blakiston  will  be  an  event  of  interest  to  medical  students.  The  first  necessity 
to  the  aspirant  for  a  medical  'career  is  the  possession  of  a  complete  and  sys- 
tematic manual  of  anatomy.  The  volume  before  us  is  admirable  in  every  way. 
It  is  magnificently  illustrated  in  colors,  and  a  specially  valuable  feature  is 
the  mode  of  describing  the  illustrations  in  the  text,  which  almost  amounts  to 
a  demonstration.  The  different  sections  have  been  compiled  by  authors  spe- 
cially qualified  for  the  duties  they  assume.  The  illustrations  have  all  been  cut 
on  wood  from  drawings  made  by  special  artists.  The  reading  matter  is 
terse  and  forcible.     The  superfluous  has  been  rigorously  suppressed. 

"The  student  searching  for  a  manual  with  which  to  begin  his  medical 
studies  should  certainly  consider  the  claims  of  this  handsome  volume  before 
committing  himself  irrevocably  to  any  particular  standard  text-book." — The 
Physictati  and  Surgeon,  Ann  Arbor,  Mich. 

The  Prices  of  all  Books  are  Net. 


AN   EMINENTLY   PRACTICAL   BOOK. 

Moullin's  Surgery, 

Second  Edition,  Enlarged. 

A  Complete  Practical  Treatise  on  Surgery,  with  Special  Reference  to  Treatment. 

By  C.  W.  MANSELL  MOULLIN,  M.A.,  M.D.  Oxon.,  F.R.C.S., 

Surgeon  and  Lecturer  on  Physiology  to  the  London  Hospital,  etc. 


Second  American   Edition, 

Edited  by  JOHN  B.  HAMILTON,  M.D.,  LL.D., 

Professor  of  the  Principles  of  Surgery  and  Clinical  Surgerj',  Rush  Medical  College,  Chicago  ;   Professor  of 

Surgery,  Chicago  Polyclinic  ;   Formerly  Supervising  Surgeon-General,  U.  S.  Marine  Hospital 

Service ;  Surgeon  to  Presbyterian  Hospital,  St.  Joseph's  Hospital,  and  Central 

Free  Dispensary,  Chicago,  etc. 

About  Six  Hundred  Illustrations, 

Over  two  hundred  of  which  are  original  with  this  work,  and  many  of  which  are 
printed  in  several  colors. 

Royal  Octavo.     1200  Pages.     Handsome  Cloth,  $6.00  ;  Leather,  Raised  Bands, 
$7.00;  Half  Russia,  Crushed,  Marble  Edges,  $8.00. 

THESE  Prices  are  Absolutely  net. 

Of  the  600  illustrations  over  two  hundred  have  been  specially  prepared  for  this 
work,  and  their  originality  adds  great  value  to  their  usefulness  and  at  the  same  time  exemplifies 
the  character  of  the  whole  book,  in  that  it  has  been  worked  up  from  modern  ideas  and  methods 
instead  of  being  a  mere  rehash  of  the  sayings  and  doings  of  others.  The  illustrations  will  excite 
particular  attention  on  account  of  their  practical  bearing  on  useful  points  in  Surgery.  By  the 
addition  of  colors  to  many  of  these  the  text  is  thoroughly  elucidated,  impressing  at  once  upon 
the  mind  of  the  Surgeon  or  Student  the  real  relations  of  important  parts  of  the  Anatomy,  and 
certain  particular  diagnostic  features.  This  is  especially  patent  in  the  article  on  tumors,  where 
the  illustrations  of  sections  of  the  various  growths  have  been  colored  so  as  to  bring  out  with 
great  clearness  their  differential  diagnosis. 

From  the  New  York  Medical  Record. 

"  Special  attention  is  given  throughout  to  treatment,  and  the  discussion  of  controverted 
points  on  pathology,  etc.,  is  relegated  to  the  background.  The  key-note  is  the  idea  that  the  chief 
aim  and  object  of  surgery  at  the  present  day  is  to  assist  the  tissues  in  every  possible  way  in  their 
struggle  against  disease. 

"  From  such  a  standpoint  it  goes  without  saying  that  the  writer's  attitude  is  a  conservative 
one.  He  is,  however,  free  from  hesitancy,  and  shows  a  keen  appreciation  of  the  rapid  strides 
of  surgical  art  in  the  last  decade.  No  less  than  two  hundred  of  the  illustrations  were  drawn 
expressly  for  this  work.  It  has  all  the  conciseness  of  Druitt's  well-known  work,  and  the 
advantage  of  a  somewhat  more  extensive  description  of  certain  conditions  occurring  in  practical 
work." 
.8®=A  complete  circular,  with  sample  pages,  press  notices,  etc.,  will  be  sent  free  upon  application. 

The  Prices  of  all  Books  are  Net. 


From  The  Southern  Clinic. 

"  'We  know  of  no  series  of  books  issued  by  any  house  that  so  fully  meets  our  approval  as  these 
?  Quiz-Compends  ?.  They  are  well  arranged,  full,  and  concise,  and  are  really  the  best  line  of  text- 
books that  could  be  found  for  either  student  or  practitioner." 


BLAKISTON'S  ?QUIZ=COMPENDS? 

The  Best  Series  of  Manuals  for  the  Use  of  Students. 

Price  of  each.  Cloth,  .80.  Interleaved,  for  taking  Notes,  $1.25. 

49*  These  Compends  are  based  on  the  most  popular  text-books  and  the  lectures  of  prominent  professors, 
and  are  kept  constantly  revised,  so  that  they  may  thoroughly  represent  the  present  state  of  the  subjects  upon 
which  they  treat. 

J^=-  The  authors  have  had  large  experience  as  Quiz-Masters  and  attaches  of  colleges,  and  are  well 
acquainted  with  the  wants  of  students. 

49~  They  are  arranged  in  the  most  approved  form,  thorough  and  concise,  containing  over  600  fine  illustra- 
tions, inserted  wherever  they  could  be  used  to  advantage. 

*^  Can  be  used  by  students  of  an^  college. 

49"  They  contain  information  nowhere  else  collected  in  a  such  a  condensed,  practical  shape. 

ILLUSTRATED  CIRCULAR  FREE. 

No.  I.  HUMAN  ANATOMY.  Fifth  Revised  and  Enlarged  Edition.  Including  Visceral  Anatomy.  Can 
be  used  with  either  Morris's  or  Gray's  Anatomy.  117  Illustrations  and  16  Lithographic  Plates  of  Nerves  and 
Arteries,  with  Explanatory  Tables,  etc.  By  Samuel  O.  L.  Potter,  m.d..  Professor  of  the  Practice  ot 
Medicine,  Cooper  Medical  College,  San  Francisco  ;  late  A.  A.  Surgeon,  U.  S.  Army. 

No.  a.  PRACTICE  OF  MEDICINE.  Part  I.  Fifth  Edition,  Revised,  Enlarged,  and  Improved.  By 
Dan'l  E.  Hughes,  m.d.,  Physician-in-Chief,  Philadelphia  Hospital,  late  Demonstrator  of  Clinical  Medi- 
cine, Jefferson  Medical  College,  Philadelphia. 

No.  3.  PRACTICE  OF  MEDICINE.  Part  II.  Fifth  Edition,  Revised,  Enlarged,  and  Improved.  Same 
author  as  No.  2. 

No.  4.  PHYSIOLOGY.  Seventh  Edition,  with  new  Illustrations  and  a  table  of  Physiological  Constants. 
Enlarged  and  Revised.  By  A.  P.  Brubaker,  m.d..  Professor  of  Physiology  and  General  Pathology  in  the 
Pennsylvania  College  of  Dental  Surgery;  Demonstrator  of  Physiology,  Jefferson  Medical  College,  Phila- 
delphia. 

No.  5.  OBSTETRICS.  Fifth  Edition.  By  Henry  G.  Landis,  m.d.  Revised  and  Edited  by  Wm.  H. 
Wells,  m.d..  Assistant  Demonstrator  of  Obstetrics,  Jefferson  Medical  College,  Philadelphia.  Enlarged. 
47  Illustrations. 

No.  6.  MATERIA  MEDICA,  THERAPEUTICS,  AND  PRESCRIPTION  WRITING.  Sixth 
Revised  Edition  (U.  S.  P.  1890).  By  Samuel  O.  L.  Potter,  m.d.  Professor  of  Practice,  Cooper  Medical 
College,  San  Francisco  :  late  .A    A.  Surgeon,  U.  S.  Army. 

No.  7.  GYN.ECOLOGY.  A  New  Book.  By  Wm.  H,  Wells,  m.d..  Assistant  Demonstrator  of  Obstetrics, 
Jefferson  College,  Philadelphia.     Illustrated. 

No.  8.  DISEASES  OF  THE  EYE  AND  REFRACTION.  Second  Edition.  Including  Treatment  and 
Surgery.     By  L.  Webster  Fox,  m  d  ,  and  Gecirge  M.  Gould,  m.d.    With  39  Formulae  and  71  Illustrations. 

No.  9.  SURGERY,  Minor  Surgery,  and  Bandaging.  Fifth  Edition,  Enlarged  and  Improved.  By 
Orville  HoRWiTZ,  B.S.,  M.D.,  Clinical  Professor  of  Genito-Urinary  Surgery  and  Venereal  Diseases  in  Jef- 
ferson Medical  College  ;  Surgeon  to  Philadelphia  Hospital,  etc.     With  98  Formulae  and  71  Illustrations. 

No.  10.  MEDICAL  CHEMISTRY.  Fourth  Edition.  Including  Urinalysis,  Animal  Chemistry', Chemistry 
of  Milk,  Blood,  Tissues,  the  Secretions,  etc.  By  Henkv  Leffmann,  m.d.,  Profe.ssor  of  Chemistry  in 
Pennsylvania  College  of  Dfintal  Surgery  and  in  the  Woman's  Medical  College,  Philadelphia. 

No.  II.  PHARMACY.  Fifth  Edition.  Based  upon  Prof.  Remington's  Text-Book  of  Pharmacy.  By  F. 
E.  Stewart,  m.d.,  ph. g.,  late  Quiz-Master  in  Pharmacy  and  Chemistry,  Phil.idelphia  College  of  Pharmacy  ; 
Lecturer  at  Jefferson  Medical  College.     Carefully  revised  in  accordance  with  the  new  U.  S.  P. 

No.  12.  VETERINARY  ANATOMY  AND  PHYSIOLOGY.  Illustrated.  By  Wm.  R.  Ballou,  m  p  . 
Professor  of  Equine  Anatomy  at  New  York  College  of  Veterinary  Surgeons ;  Physician  to  Bellevue  Di^- 
pensary,  etc.     With  29  graphic  Illustrations. 

No.  13.  DENTAL  PATHOLOGY  AND  DENTAL  MEDICINE.  Second  Edition,  Illustrated.  Con- 
taining all  the  most  noteworthy  points  of  interest  to  the  Dental  Student  and  a  Section  on  Emergencies.  By 
Geo.  W.  Warren,  d.d  s.,  Chief  of  Clinical  Staff,  Pennsylvania  College  of  Dental  Surgery,  Philadelphia. 

No.  14.  DISEASES  OF  CHILDREN.  Colored  Plate.  By  Marcus  P.  Hatfield,  Professor  of  Dis- 
eases of  Children,  Chicago  Medical  College. 

No.  15.  GENERAL  PATHOLOGY  AND  MORBID  ANATOMY.  91  Illustrations.  By  H.  New- 
berry Hall,  ph.g.,  m.d.,  Professor  of  Pathology  and  Medical  Chemistry,  Chicago  Post-Graduate  Medical 
School :  Member  Surgical  Staff,  Illinois  Charitable  Eye  and  Ear  Infirmary  ;  Chief  of  Ear  Clinic,  Chicago 
Medical  College. 

No.  16.     DISEASES  OF  NOSE  AND  EAR.     Illustrated.     Same  Author  as  No.  15. 

Price,  each,  .80.       Interleaved,  for  taking:  Notes,  $1.25. 

P.   BLAKISTON,  SON  &  CO.,  Publishers. 

IOI2  Walnut  Street,  Philadelphia. 
The  Prices  of  all  Books  are  Net. 


Published  Annually  for  45  Years. 


The  PHYSICIAN'S  Visiting  List. 

(LINDSAY  &  BLAKISTON'S.) 

Special  Improved  Edition  for  1896. 


In  order  to  improve  and  simplify  this  Visiting  List  we  have  done  away  with  the  two 
styles  hitherto  known  as  the  "  25  and  50  Patients  plain."  We  have  allowed  more  space 
for  writing  the  names,  and  added  to  the  special  memoranda  page  a  column  for  the 
"Amount"  of  the  weekly  visits  and  a  column  for  the  "Ledger  Page."  To  do  this  with- 
out increasing  the  bulk  or  the  price,  we  have  condensed  the  reading  matter  in  the  front 
of  the  book  and  rearranged  and  simplified  the  memoranda  pages,  etc.,  at  the  back. 

The  Lists  for  75  Patients  and  100  Patients  will  also  have  special  memoranda  page  as 
above,  and  hereafter  will  come  in  two  volumes  only,  dated  January  to  June,  and  July  to 
December.  While  this  makes  a  book  better  suited  to  the  pocket,  the  chief  advantage  is 
that  it  does  away  with  the  risk  of  losing  the  accounts  of  a  whole  year  should  the  book 
be  mislaid. 

Before  making  these  changes  we  have  personally  consulted  a  number  of  physicians 
who  have  used  the  book  for  many  year^,  and  have  taken  into  consideration  many  sugges- 
tions made  in  letters  from  all  parts  of  the  country. 


CONTENTS. 

PRELIMINARY  MATTER. — Calendar,  1896-1897 — Table  of  Signs,  to  be  used  in  keeping  records — 
The  Metric  or  French  Decimal  System  of  Weights  and  Measures — Table  for  Converting  Apothecaries' 
Weights  and  Measures  into  Grams — Dose  Table,  giving  the  doses  of  official  and  unofficial  drugs  in  both 
the  English  and  Metric  Systems — Asphyxia  and  Apnea — Complete  Table  for  Calculating  the  Period  of 
Utero- Gestation — Comparison  of  Thermometers. 

VISITING  LIST. — Ruled  and  dated  pages  for  25, 50,  75,  and  100  patients  per  day  or  week,  with  blank  page 
opposite  each  on  which  is  an  amount  column,  column  for  ledger  page,  and  space  for  special  memoranda. 

SPECIAL  RECORDS  for  Obstetric  Engagements,  Deaths,  Births,  etc.,  with  special  pages  for  Addresses 
of  Patients,  Nurses,  etc..  Accounts  Due,  Cash  Account,  and  General  Memoranda. 


SIZES  AND   PRICES. 

REGULAR  EDITION,  as  Described  Above. 

BOUND   IN   STRONG   LEATHER  COVERS,  WITH    POCKET  AND    PENCIL. 

For  25  Patients  weekly,  with  Special  Memoranda  Page, $1  00 

50        "  "  "  "  "         I  25 

<.  II  «  ^  1     r  January  to  Tune    "|  ^  „^ 

CO        "  "  "  "  "        2  vols.  K  T  1     i     -TV         I       y 2  00 

■'  (  July  to  December  j 

/<  Li  «  ii  «        „      1      f  January  to    June    )  „  ,^ 

71:         "  "  "  "  "        2  vols.  <  i  ,     ^^  T\    ■'     ,       > 200 

'■'  I  Ji^ly  to  December  J 

ion        "  «  "  «  "        2  vols  i  January  to  June    ■>  • 

'°°  ^  '"'''•  t  July  to  December  |     ....•-    2  25 

PERPETUAL  EDITION,  without  Dates. 

No.  I.  Containing  space  for  over  1300  names,  with  blank  page  opposite  each  Visiting  List  page. 

Bound  in  Red  Leather  cover,  with  Pocket  and  Pencil, ^i  25 

No.  2.  Same  as  No.  i.     Containing  space  for  2600  names,  with  blank  page  opposite, i  50 

MONTHLY  EDITION,  without  Dates. 

No,  I.  Bound,  Seal  leather,  without  Flap  or  Pencil,  gilt  edges, 75 

No.  2.  Bound,  Seal  leather,  with  Tucks,  Pencil,  etc.,  gilt  edges, i  00 

jg^"  All  these  prices  are  net.     No  discount  can  be  allowed  retail  purchasers. 
Circular  and  sample  pages  upon  application. 

P.   BLAKISTON,  SON  &  CO.,  Publishers,  Philadelphia. 


COLUMBIA  UNIVERSITY  LIBRARIES  (hsi  SU) 

RK  701  G67  1895  C.I 

Denta:  : —:  i  ■  ■=.  a  manual  of  dental  mate 


2002448815 


L 


Gorgas 

L.ental  medicine- 


G67 

1896 


